Douglas Alexander: On 18 June, the Foreign Secretary met her European Union counterparts and agreed to resume normal relations with the Palestinian Authority. The EU is now working to put in place practical and financial assistance. My predecessor spoke to Prime Minister Fayyad on 27 June about this. British and European Commission officials are now on the ground, arranging the details.

Malcolm Bruce: I, too, welcome the right hon. Gentleman to his post. The ambitions of his Department carry strong support throughout the House and we wish him well in achieving them.
	On the problems of Palestine, does the right hon. Gentleman acknowledge that although working, as we must, with President Abbas, he is not the sole spokesman of the Palestinian people, and that his Prime Minister, able as he is, is not the popular choice of the Palestinian Authority? How can the Secretary of State ensure that aid is delivered effectively in Gaza, with the temporary international mechanism and where the Administration is not one with which the Quartet is prepared to engage? Can he ensure that services will be delivered effectively in the long term in Gaza?

Andrew Mitchell: We welcome the Secretary of State to his new responsibilities and the Minister to his expanded responsibilities on trade. Further to the Minister's remarks about the need for the Americans to move in these negotiations, is he aware that while exports of clothes and garments from African countries to America have increased sevenfold over the last five years, the same exports to Europe have actually declined? What plans does he have to increase the ability of African countries to sell into Europe; and is he seeking to change the rules of origin requirements, which are at least partly to blame for the problem?

Gareth Thomas: The hon. Gentleman is right to highlight the importance of these trade negotiations in the effort to reverse the decline in the share of trade to Africa, particularly in respect of agricultural products. He is right to say that we need radical reform of the rules of origin requirements and we continue to press the EU to offer a more generous system for those rules. That is why my right hon. Friend the former Secretary of State for Trade and Industry and current Chancellor, in partnership with colleagues in other European countries, wrote to a number of Commissioners to press for progress on those rules of origin. We do need greater progress from our American allies, particularly in respect of allowing Africa to increase its trade of cotton into American and EU markets.

Andrew Mitchell: On the issue of the EU, the Minister will be closely following the discussions between the European Commission and developing countries about economic partnership agreements. If EPAs cannot be negotiated and agreed by December, will the British Government accept the Commission's imposing of the generalised system of preferences, or will the Minister press for an extension of the WTO waiver?

Shahid Malik: The Department for International Development supports initiatives that enable poor people to benefit from markets and improve how Government systems respond to the needs of poor people. We do that through three routes: first, through the World Bank and the Inter-American Development Bank, whose projects include improving social services and helping municipalities to be more responsive to their constituents; secondly, through the European Union, whose projects include supporting indigenous farmers; thirdly, through UK non-governmental organisations which support grass-roots groups.

Douglas Alexander: Thank you, Mr. Speaker. I have the disconcerting sense that the Chamber is filling up; I usually have the opposite effect.
	Aid is distributed on the bases of need and the likelihood of its effectiveness in reducing poverty. Many of the countries to which the Government return failed asylum seekers receive considerable amounts of aid, including programmes to improve the lives and opportunities of children and young people.

Gordon Brown: Before listing my engagements, I am sure that the whole House will wish to join me in sending our profound condolences to the families and friends of the three servicemen killed in Iraq at the weekend. They were Private Edward Vakabua of 4th Battalion the Rifles, Lance Corporal Ryan Francis of 2nd Battalion the Royal Welsh, and Corporal Christopher Read of 3rd Regiment Royal Military Police. They died doing vital work for our country. We owe them a deep debt of gratitude.
	This morning, I had meetings with ministerial colleagues and others. In addition to my duties in the House, I shall have further such meetings today.

David Cameron: I join the Prime Minister in paying tribute to Corporal Christopher Read, to Lance Corporal Ryan Francis, and to Rifleman Edward Vakabua, who died serving their country.
	Last week, the Government announced a fundamental review of the NHS. Will the Prime Minister confirm that no hospital closures or service reductions will take place until that review is completed?

Gordon Brown: Lord Darzi is not proposing the closure of existing hospitals. It is hardly surprising that people asked whether they want their hospital closed might say no, but Lord Darzi is not proposing that. He is proposing 150 new polyclinics, which will mean that doctors can get consultants into their surgeries to perform much needed operations that can be done there. He is proposing the expansion of specialist care, and that the teaching hospitals are able to do more research. I think that the Leader of the Opposition would do better to look at the report before commenting on it.

David Cameron: Let me just remind the Prime Minister of what Lord Ara Darzi says. He says:
	"the days of the district general hospital...are over"
	and that we need
	"fewer, more advanced hospitals".
	That would mean that maternity units, accident and emergency units and specialist services will go. Is not the truth that his health policy— [Interruption.]

David Cameron: The truth is they know that it means cuts in NHS services. Is not the truth that the Prime Minister's health policy is exactly the same as it ever was: more closures, more removal of services and more job losses? Does not the report, out today, show that all we shall get is more of the same from a Government who have failed?

Gordon Brown: It is very interesting that the leader of the Conservative party did not ask anything about the married couple allowance or tax credits and that it has been left to the leader of the Liberal party to pick up the baton. Tax credits are the most successful policy in removing child poverty in this country: 6 million families benefit from tax credits. Yes, there was computer error to start with, but it is being substantially reduced and the right hon. and learned Gentleman should admit that 600,000 children are not in poverty today because they are receiving tax credits.

Alan Simpson: The Prime Minister will know that tens of thousands of families around the land fear that their housing futures will be plagued by the prospect of regular flooding and ultimate uninsurability. Given the pressure that he is under to approve further development on floodplain land, will he consider making the developers liable for full insurance cover for development on such land for the first 20 years of the life of the developments, rather than leaving the tenants and owners of properties to be both victims financially and victims of flooding?

Gordon Brown: I shall certainly look at my hon. Friend's proposal, but we are increasing flood prevention moneys from £600 million to £800 million. I visited the areas subjected to the worst of the floods over the past few weeks. On Saturday, I visited a number of people who are not insured, and we have to do something to help them in those circumstances. I talked to local authorities and we gave them special help to get over the difficult circumstances now. We also have to help them with reconstruction, but I hope my hon. Friend agrees that to increase the flood prevention budget from £600 million to £800 million, at a time when we have other priorities to meet, is a sign of our determination to deal with the proper defences against floods.

Andrew Rosindell: I am delighted that the Prime Minister has at long last decided to join my campaign to fly the Union flag from every public building throughout the United Kingdom, but when is he going to start treating my constituents in England in the same fair way he treats his constituents in Scotland and give us English votes for English laws?

Gordon Brown: What we are trying to do with maternity care is to give every mother a choice. Having had access to a midwife, they will have the choice of having the birth at home, in a midwife-led unit, or in a maternity unit staffed by consultants and doctors. That choice will be open to every mother from 2009, and I hope that the hon. Gentleman will support that extension of choice, which means that there are more doctors and more nurses, and more midwives helping them.

Gordon Brown: The hon. Gentleman should understand the devolution settlement. This Parliament voted the right to make decisions on health to Scotland and Wales. It also voted the right to make decisions on specific issues to London. It is right that the House of Commons can make those decisions, but having made them and the Conservative party having said that it accepts devolution, it is a bit much for Conservatives now to change their mind.

Gordon Brown: For over one and a half centuries, the annual Gracious Address has been drafted inside Government and agreed by the Cabinet far from the public arena, but I believe that it is right, in the interests of good and open government and public debate, that each year the Prime Minister make a summer statement to the House so that initial thinking, previously private, can be the subject of widespread and informed public debate. Today, in advance of final decisions, the Leader of the House is publishing details of our initial list of proposed legislative measures, inviting debate on them in both Houses this month and making provision for region-by-region deliberation and responses.
	To respond to the rising aspirations of the British people we must deliver new and better opportunities in education, employment and the provision of housing and health care, and ensure that in a fast-changing world there is opportunity and security not just for some people, but for all British people. A new educational opportunity Bill will mean that for the first time not just some but all young people will be able to stay in education or training until the age of 18. The new pensions Bill will ensure that, for the first time, not just some but all working people have the right to a workplace pension, with a duty on every employer to contribute towards it.
	Putting affordable housing within the reach of not just the few but the many is vital both to meeting individual aspirations and to securing a better future for our country, so for housing and planning in the 2007-08 Session there are three proposed legislative measures. Let me tell the House the scale of the new opportunities for home buying and to rent that we are proposing. In two eras of the last century—the inter-war years and the 1950s onwards—Britain made new house building a national priority. Now, through this decade and right up to 2020, I want us, in environmentally friendly ways, using principally brownfield land and building eco-towns and villages, to meet housing need by building over 250,000 more homes than previously planned. That would be a total by 2020 of 3 million new homes for families across the country. For England, we will raise the annual house building target for 2016 from 200,000 houses a year to 240,000 new homes a year.
	We propose a new housing Bill that will support and encourage initiatives on the ground by local authorities and other authorities. We will bring together English Partnerships and the Housing Corporation to create a new homes agency charged with bringing surplus public land into housing use to deliver more social and affordable housing and to support regeneration. This work will include new partnerships with local authorities, health authorities and the private and voluntary sectors to build more housing made affordable by shared equity schemes and more social housing responsive to individual needs.
	The planning Bill will implement the Eddington and Barker reports to speed up the development of major infrastructure projects that Britain now needs to facilitate economic and housing growth, and it will speed up planning generally. The planning gain supplement Bill—to ensure that the public benefit from planning gain—is provisional, because if, prior to the pre-Budget report, a better way is identified of ensuring that local communities receive significantly more of the benefit from planning gain, including to invest in necessary infrastructure and transport, and it is demonstrated that it is a better alternative, the Government will be prepared to defer next Session's legislation.
	To move housing supply forward, English Partnerships is negotiating a new deal with the Ministry of Defence to acquire at least six major redundant sites. Similar discussions are being undertaken with the Department for Transport, the Highways Agency and the British Railways Board residuary body, and the Department of Health is undertaking an urgent review of surplus land owned by NHS organisations and trusts. I can announce that in total over 550 sites owned by central Government are now being examined for housing development, with the potential for up to 100,000 new homes. In addition, we estimate that another 60,000 homes can be built on brownfield land currently owned by local authorities. The Minister for Housing will publish further details next week in a Green Paper to this House.
	The Chancellor of the Exchequer is announcing today that he will consult on creating a new regime for "covered bonds" to help mortgage lenders to finance more affordable 20 to 25-year fixed-rate mortgages, and he will report by the Budget on how to overcome other barriers that prevent lenders from offering people long-term mortgages, including the case for changes to instruments used by the Debt Management Office.
	At the same time as building more affordable homes we must reduce the environmental impact, so we will consult local councils on using the New Towns Acts to enable eco-towns with zero or low-carbon housing and to ensure that they are built more quickly. I assure the House that we will continue robustly to protect the land designated as green belt.
	Alongside this, measures in the Climate Change Bill, which was published in draft on 13 March, will make Britain the first country in the world to introduce a legal framework for reducing carbon emissions by setting targets for carbon emission reductions for each five-year period to 2050. The energy Bill will also provide greater incentives for renewable energy generation. The local transport Bill will support the Government's strategy to tackle congestion and to improve public transport.
	I turn to some of the other proposed Bills in our programme. As we approach the 60th anniversary of the NHS, we will do more to put power in the hands of patients and staff and ensure that every patient gets the best treatment. Alongside the NHS review announced last week, the health and social care Bill will create a stronger health and social care regulator, and there will be a clear remit to ensure improved access, clean and safe services, and high-quality care.
	The children in care Bill is an attempt to do more to protect vulnerable children. The child maintenance Bill will do more to prevent children from falling into poverty when parents split up. Behind the unclaimed assets Bill is our determination that money in dormant bank accounts will be used to improve our country's youth and community facilities. The Human Tissue and Embryos Bill has already been published in draft for discussion.
	Measures to support British businesses as they strive to succeed in the new global economy and to break down the barriers holding enterprise back include the enforcement and sanctions Bill, which will keep the burden of regulation on compliant businesses to a minimum while effectively targeting and penalising those deliberately disregarding the law. The employment simplification Bill will deliver simpler and fairer enforcement of the national minimum wage.
	Protecting the security and safety of the British people is paramount for every Government. We stand ready to introduce new measures into the Criminal Justice Bill, which will be carried over into the next Session, including measures that come from the review of policing by Sir Ronald Flanagan, which will report later this autumn. We are committed to building a broad consensus on the right balance between protecting our national security and safeguarding the civil liberties of every individual in this country, so the Home Secretary plans to consult on, and we will seek an all-party consensus on, new measures to ensure more successful prosecutions against terrorist suspects and increased penalties for terrorists charged with other criminal offences. We will consult on, and hope to achieve a consensus on, the period of pre-charge detention where, for terrorism alone, exceptional circumstances in my view make it necessary, while ensuring rigorous judicial oversight and parliamentary accountability, that we extend the time. As the House knows, we shall review the use of intercept material in prosecutions.
	The full and final programme will be set out in the Queen's Speech in November. Many of the proposals that I set out to the House last week will also be taken forward in a constitutional reform Bill. Just as with the challenge of securing justice and security for all, the challenge for the Government and the foundation of next Session's legislative programme is to support all parents with children, not just some; to invest in the educational chances of all young people, not just a few; to offer more people the chance to get on the housing ladder for the first time; to help more people into work; and to give all patients the best health care. In this way, we respond to the rising aspirations of the British people, by ensuring that the opportunities that are today available to only some are available to all. I commend the statement to the House.

David Cameron: Let us take a look at the areas where we agree. As I have said before, we shall work with the Government on anti-terror legislation to make this country safe from terrorists. I am glad that the Prime Minister has agreed to my proposal for the Privy Council committee to consider the use of intercept evidence. He has also taken up our idea of interviews after charge. He has said again today that he is considering our border police proposals. Will he confirm that they could be introduced in the Queen's Speech this year?
	Let us look at other proposals. On housing, the Prime Minister says that it is difficult for people to get their foot on the housing ladder, but who does he think is responsible for that? It was his Government who doubled the council tax, restricted the right to buy and increased stamp duty, including for first-time buyers. As a result, will he confirm that home ownership in Britain is actually falling for the first time since figures were published? Is that not Labour's record on housing? As Chancellor, he launched the planning gain supplement in a great blaze of glory, but is he not back-pedalling on it today? As he broke the housing ladder, why should anyone think that he is the right person to mend it?
	The Prime Minister promised action on the NHS. Why does he not listen to his own Health Secretary, who has said that there is
	"confusion and frustration in the NHS"?
	Who has been running the NHS for these past 10 years? The Health Secretary has said:
	"Doctors, clinicians and nurses complain that they are fed up with too many top-down instructions".—[ Official Report, 4 July 2007; Vol. 462, c. 961.]
	Who has been responsible for the top-down instructions over the past decade? Today, we have an NHS in which nurses are being sacked, accident and emergency units are closing and junior doctors are having to leave the country to look for work. A week ago, the Prime Minister announced a fundamental review of the NHS. Today, he is promising fundamental legislation on the NHS. Either the review is bogus or the legislation has not been thought through, or—knowing this Government—probably both.
	Ten years ago, the Government said that education was their priority, yet 10 years later almost half of our 11-year-olds cannot read, write or add up properly. The number of young people not in work, education or training has actually gone up under this Government to over 1 million. The one change that the Prime Minister and his new Secretary of State for Children, Schools and Families are making seems to be going in entirely the wrong direction. Does not the Prime Minister intend to dilute the reform agenda by giving academies less independence? What we need is more freedom for schools, more power for head teachers and more choice for parents. While the previous Prime Minister was beginning to move in the right direction on education, is this one not moving in the wrong direction?
	The Prime Minister has talked about the constitution. We proposed, and will support, measures that genuinely strengthen Parliament and decentralise power. However, real change means giving the House of Commons the right to determine its own timetable; real change means a proper bill of rights to replace the Human Rights Act 1998; and, I have to say to the Prime Minister, real change means addressing the West Lothian question. I ask him again: where is the fairness in allowing Scottish MPs the right to vote on hospitals, schools and housing in my constituency, while no MP is allowed to vote on hospitals, schools and health in his constituency?
	So much for what was in the draft Queen's Speech; let us see what was left out. There was nothing in this speech to address Britain's broken society. Where are the measures to address teenage pregnancy, drug addiction and personal debt? Where are the measures to strengthen families and marriage? Where is the package to tackle the highest rate of family breakdown in Europe? The Prime Minister knows that he cannot tackle social breakdown because he has presided over social breakdown.
	The Prime Minister tells us that he wants to be accountable to Parliament, so let us see whether he can ditch the usual pre-prepared rant and answer three questions. First, he says that there will be a pensions Bill. Will it give faster help to the 125,000 people who have been left with no pension under his Government? Secondly, will he announce a moratorium on A and E and maternity unit closures, and an end to the top-down targets that are leading to NHS cuts? Thirdly, will he give the British people a referendum on the European constitution, which they all want? Three straight questions; let us have three straight answers.
	Will not people conclude from what they have heard today that all this Prime Minister has to offer is more of the same from a Government who have failed?

Gordon Brown: The answers to the right hon. Gentleman's three questions are: first, we will deal with the problems that are facing those who have lost their pensions as a result of their companies collapsing. We have instructed a review of the assets of bankrupt companies and their pension funds, and we believe that we will be able to move the 80 per cent. guarantee that we have given further towards to 90 per cent. We will make an announcement very soon.
	On the second issue of A and E, I say to the right hon. Gentleman exactly what I said to him at Prime Minister's questions: all seven reconfigurations have been referred to the medical committee, which will review them on medical and surgical grounds. I would have thought that he would be gracious enough to support that move. On his third question, on the European referendum, I think that he should listen to some other voices in his own party. The debate within his own party is raging at the moment, with Lord Heseltine saying that, as a result of our achieving our red lines in the negotiations, if we can secure the amending treaty, there is no case for a referendum. Perhaps, in the spirit of consultation, the right hon. Gentleman should consult his own party on these matters.
	On housing, we have just raised the level of house building commitment to 240,000 houses a year. We have just released a lot of public sector land, and announced that 500 more sites are being examined with a view to releasing land for housing. At the same time, we are creating the new homes agency to bring together all the agencies that can help. I am disappointed, therefore, that the right hon. Gentleman says that there is nothing in that for the Conservative party. The reason there is nothing in it for the Conservative party in that the shadow housing Minister has said that
	"you cannot build your way out of housing problems."
	The leader of the Conservative party has something to answer for, too. He told the Conservative party conference, when he was trying to speak to young people:
	"If we are to be the party of aspiration...that means building more houses and flats for young people."
	He then spoke to Age Concern, the pensioners organisation, and said that his policy was
	"fewer homes designed for young single people."
	I hope that the Conservative party will find a way to support many of the measures that we propose. There was general agreement in this House about some of the measures in the constitutional reform Bill. I hope that the right hon. Gentleman will support us on the counter-terrorism Bill. Employers and trade unions have agreed on the employment simplification Bill. I believe that there is a growing consensus about what we have to do on human tissues and embryos. I hope that on the unclaimed assets Bill, which gives money to youth services, we will not find a reluctant Conservative party unwilling to support it.
	I hesitate to think what a Conservative Queen's Speech would look like in the present circumstances. "No more grammar schools" was a policy that was publicised one week, but abandoned the next; then there were to be museum charges—publicised one week, abandoned the next; then there was to be VAT on airline flights—publicised one week, abandoned the next; and then, this week, there were to be taxes on alcohol—said on Monday, abandoned by Tuesday. Then, of course, the shadow education Secretary, who led the clause 4 moment on grammar schools, was himself abandoned by the Conservative leader. It is U-turn after U-turn after U-turn in the Conservative party. The Conservative leader may U-turn if he wants; it is clear that the Conservative party is not for turning.

Menzies Campbell: If these proposals represent a genuine attempt by the Government to consult in advance of the Queen's Speech, they most certainly should be welcomed, but I say to the Prime Minister that we should be concerned about the quality of legislation as much as we are about the quantity. I hope that he feels it appropriate to ensure that there is much more pre-legislative scrutiny during his time in No.10 Downing street than there has been hitherto. It is worth pointing out that during the past 10 years, there have been 382 Acts of Parliament, including 10 health Acts, 12 education Acts and 29 criminal justice Acts, and more than 3,000 new criminal offences have been created. The mantra might have been, "Education, education, education", but the reality has been, "Legislation, legislation, legislation."
	I shall deal with some of the points raised in the Prime Minister's statement. On the issue of education, he said that it is the Government's intent to raise —[ Interruption. ]

Menzies Campbell: The Prime Minister has said that the Government intend to raise the school-leaving age to 18 years. How will the curriculum be made relevant to those who find themselves in school between the ages of 16 and 18, who might otherwise have anticipated leaving? What funding will be made available to ensure that that curriculum is worth while and constructive?
	On housing, I state right at the outset that local planning gain should be locally located and controlled. I hope that in the consideration the Prime Minister is obviously willing to give to this issue, he will ensure that local authorities can reap the benefit of development within their areas, and determine in consultation with their citizens how that benefit should be supplied.
	Since 1997, the number of families on social housing lists has risen by 50 per cent., from approximately 1 million to 1.5 million. That is a measure of the seriousness of the crisis, which is why I welcome the Prime Minister's attention to the issue. I suggest that we probably need as many as 1 million socially rented houses by 2020. He would help the House if he gave a more detailed breakdown of how the 3 million target will be made up. I hope that he and the whole House are sympathetic to the fact that by 2020, less than 10 per cent. of the total housing stock will be carbon neutral. If we are serious about dealing with climate change, surely more has to be done in relation to housing.
	We do not have to go very far in the national health service to meet doctors, nurses and health professionals who are demoralised and confused by constant reorganisation. Any legislation that the Government introduce must surely focus on standards, and not on yet another restructuring.
	We will obviously consider with care any proposals that the Government make on terrorism. We, of course, have previously argued for the use of intercept evidence—phone-tap evidence—in court proceedings, and for the notion of questioning suspects after charge, subject to proper judicial protection.
	On climate change, to which I already referred, I hope that the Government will look again at annual emission reduction targets. How will we know whether we are making progress unless we have some annual figure on precisely what is happening as a result of Government policies? Should not the aim be a carbon-neutral Britain? The Prime Minister must remember that green taxes fell as a percentage of national income during his period at the Treasury.
	On climate change and the environment, will he categorically state today that there will be no open or, indeed, hidden public subsidy for the nuclear industry, bearing in mind the fact that we already have a liability of about £70 billion to clean up existing nuclear power stations?
	Finally, I hope that the Government will embrace the idea that legislation, once passed, should not simply be allowed to lie on the statute book. It is time that we had a proper system of revision to repeal out-of-date, inept and ineffective legislation. If we are going to be better engaged with the quality of legislation through pre-legislative scrutiny, surely we should be equally conscientious in striking from the statute book provisions that have long since lost their use.

Gordon Brown: My hon. Friend is right to say that microgeneration has an important role to play in future. We set up a new microgeneration fund, which is heavily oversubscribed because of demand for wind turbines, solar power and other means of using energy more efficiently and in a low carbon way. We will extend that in future, but it is one part of the solution to meeting our energy needs in an environmentally friendly way. I hope that my hon. Friend will understand that the debate about nuclear power as well as that about the future of coal, oil and gas, is also important to the supply of energy.

Gordon Brown: I applaud my right hon. Friend's work as a Housing Minister and as a campaigner for more affordable housing for his constituents and the rest of this country. The Government are offering a deal; we would be prepared to withdraw the planning gain supplement Bill if we could find a means of extracting more planning gain for local communities as new housing and new infrastructure are built. We await the consultation and the responses of those who can help us to achieve that high level of planning gain.

Bob Russell: During the last ten years of the new Labour Government, only 4,000 council houses were built. In the first ten years of the Thatcher Government, 400,000 council houses were built. The Prime Minister was silent on the building of council houses. Why is he hostile towards council houses? How many of the 240,000 new homes a year will be council houses?

Robert Flello: I beg to move,
	That leave be given to bring in a Bill to establish a national compulsory proof of age scheme for persons aged between 16 and 21 years in connection with the purchase of alcohol, tobacco, knives, air weapons and other items; and for connected purposes.
	Because of the current absence of a national biometric identity card, the Bill is necessary for reasons I shall set out.
	Every day in Britain, hard-working shop workers ensure that we can get hold of everything from A to Z—from apples to cuddly zebras—and are involved in millions of transactions, many of which involve age-restricted items such as alcohol, cigarettes, knives and airguns. Conflict does not usually arise over sales of apples or cuddly toys but, sadly, it all too frequently arises over the sale of age-restricted items. Research shows that the refusal to sell age-restricted products is the most common cause of verbal abuse towards shop staff and that it can also provoke physical violence. It is believed that as many as 90 per cent. of shop workers have suffered some form of abuse, and many of them do so daily.
	As well as verbal abuse, shop workers are often subjected to physical abuse, ranging from being spat at to violent assault. For example, a shop worker who refused to serve a bottle of beer to someone whom they thought was under age was told that they would be knifed. Other shop workers report being beaten up for refusing to sell alcohol to young lads. Thankfully, according to the most recent figures, incidents of violent abuse against shop workers have declined. That is in part owing to initiatives such as the Union of Shop, Distributive and Allied Workers' successful "Freedom from Fear" campaign, and USDAW is today celebrating its "respect for shop workers day". I pay tribute to it for its work in raising the profile of the millions of shop workers who serve us each and every day.
	One way of addressing the problem of assault on shop workers is to foster a culture of "No ID, no sale", so that customers know that if they look under 21 years of age, they will need to show proof of that. That would help to defuse tension and reduce opportunities for confrontation when a customer is challenged about their age.
	I fear that the problems associated with selling age-restricted products will peak this autumn when the age at which tobacco products can be sold rises from 16 to 18. Many young people who are approaching their 18th birthday will have been buying cigarettes legally for almost two years but will no longer be able to do so. Similar increases in the minimum age for purchase will rightly apply to knives, airguns and crossbows.
	I am particularly concerned about the availability of so-called pendant knives. They look like a piece of jewellery, but they contain two blades that fold out. I was horrified to learn that that item can be sold legally as it is not a concealed blade and the blades are not long enough to make it illegal. I fail to understand how such items can be justified, but I look forward to the date when at least no one under 18 can buy one.
	The Bill has two key points: it proposes that we have a nationally recognised, Government-controlled proof of age scheme, and that that be compulsory for those aged 16 to 21 who wish to make restricted purchases. Let us be clear about what we are addressing. Tobacco and alcohol are not the only items whose purchase is age-restricted. Other age-restricted products include fireworks, which can cause great misery in the hands of people who misuse them, DVDs, videos and solvents—the problems associated with solvent misuse have been raised with the Prime Minister. Other items include aerosol paints—young people sometimes use them to put their tags on walls—lottery tickets, petrol and crossbows. It is right and proper that such items are sold only to those who are deemed to be of a suitable age.
	It would be wrong to claim that there are no voluntary schemes already in place to train and support shop workers in order to help them meet their legal obligations and check the age of customers. Many Members will be aware of the pass scheme, and I pay tribute to all involved in that, including the drinks industry which plays an active role. The pass scheme is supported by robust audits carried out by trading standards bodies, and only accredited cards may bear the registered hologram. About 2 million such cards are in use, and where they are applied, their use is beneficial. However, as well as the four national card schemes that are accredited by a pass, there are also about 20 local authority entitlement cards, which also provide proof of age, and numerous other non-accredited schemes. More worryingly, there are cards showing false details that can be downloaded and printed from the internet. Furthermore, in some parts of the country it is more usual for young people to use passports or driving licences to prove their age. I understand that it is estimated that about two thirds of those aged 18 and 19 have passports, and that a similar proportion have driving licences. Inevitably, there is a significant overlap between those two groups, so perhaps a quarter of all those aged 18 and 19 do not have some form of official Government proof of age.
	Apart from the costs involved, what are the dangers in carrying around such documents? Identity theft dangers are heightened. Passports and other documents can easily be stolen when people are on a night out. Replacing them is both costly and time consuming. It is an administrative burden for the young person, the police and the passport agency.
	There is currently a variety of proof of age cards and documents, and, although the pass hologram should be widely recognised, a young person who visits elsewhere in the country—perhaps a person from Stoke-on-Trent visiting a friend in Portsmouth—might find that his proof of age card is not recognised there. A single, national, Government-run scheme would simplify the position on proof of age by removing the myriad schemes. Its establishment would also raise the profile of the single scheme in the minds of customers.
	If we were to have compulsion, that would help create the culture we need to foster whereby anyone who looks under the age of 21—I can only wish that that included me—automatically shows their proof of age when purchasing age-restricted items. If there is a compulsion to show a proof of age card, that should take the pressure off the shop worker to have to ask to see such proof. That in turn should lead to less scope for confrontation and less abuse and assault of our shop workers. Regardless of how well a voluntary scheme might be run, I do not believe that it would stop abuse of shop workers. The scheme must be compulsory.
	Although we might no longer be described as a nation of shopkeepers, we should celebrate the work our shop workers do—often at times when the rest of the population is not at work, such as early in the morning, late in the evening, at weekends, and during holidays and bank holidays. Our shop workers deserve the greatest respect and to be treated properly. My Bill would add to the protection of those hard-working men and women. I commend the Bill to the House.
	 Question put and agreed to.
	Bill ordered to be brought in by Mr. Robert Flello, Mr. Adrian Bailey, Lyn Brown, Mr. David Kidney, Sarah McCarthy-Fry and Lynda Waltho.

Andrew Lansley: I beg to move,
	That this House notes that stroke is the third most significant cause of death and the leading cause of adult disability; believes that stroke prevention and care have received insufficient attention despite £2.8 billion in direct care costs to the NHS; welcomes the report of the National Audit Office (NAO), Reducing brain damage: faster access to better stroke care, HC 452, and the subsequent Report from the Committee of Public Accounts (PAC), of the same title, HC 911; further welcomes the Government's publication of a consultation on a national stroke strategy; commends the Stroke Association, the Different Strokes charity and the Royal College of Physicians in raising awareness of stroke and the needs of stroke patients and survivors; calls for the rapid implementation of the NAO and PAC recommendations thereby saving over 10 lives a week, delivering high-quality stroke care and securing value-for-money for NHS resources; is concerned at the continuing deficiencies in stroke care and wide disparities in access to specialist stroke services disclosed in the 2006 National Stroke Audit published in April 2007; and urges the Government to give priority and urgency to the measures needed to deliver improving outcomes for stroke patients.
	I am grateful to my colleagues for permitting me to use Opposition time to raise the important issue of stroke. I declare an interest as chair of the all-party parliamentary group on stroke and I am also grateful to the Secretary of State and his colleagues for their support of the all-party group and the Government's amendment. Unfortunately, I cannot prefer their amendment to our motion, because the latter faces up to the reality of international comparisons in stroke care and the wide discrepancies and deficiencies in it across the UK. I wish that we could have had a combined motion, because the purpose of this debate is not to engage in partisan argument, but to raise the priority of stroke care. It has been more than four years since we have had a debate on stroke in this House, including in Westminster Hall, so it is right to do so now.
	I wish to pay tribute to some people who have been instrumental in raising the priority of stroke. There are voluntary organisations, including patient representative groups such as the Stroke Association and Different Strokes, and national organisations, such as the Royal College of Physicians, which through the National Sentinel stroke audit has brought forward much vital information about the quality of stroke services and helped to push forward the improvements that have been occurring. I do not want to leave out clinical leaders such as Tony Rudd at St. Thomas's, Peter Rothwell in Oxford and Gary Ford in Newcastle, or the work of the Department of Health in the past 18 months, led by Roger Boyle, the national clinical director, and the team of officials.
	Nor should we ignore the role of the National Audit Office. The report that it produced in November 2005 was a remarkable example of the value of the NAO, not only in considering issues of value for money and public expenditure, but in examining how services can be improved in ways that have radically changed attitudes in Government about what can be achieved in stroke care.

Andrew Lansley: I am grateful to my hon. Friend for the work of not only the NAO, but the Public Accounts Committee, which has followed up on the issue in the same way as it followed up the original inquiry into health care-acquired infections. It revisited that subject and made further important recommendations, which have helped to raise the importance of the issue. He makes an important point: one of the NAO's recommendations was the need for immediate access to screening.
	At the conference organised by the NAO last October, at which my hon. Friend the Member for Gainsborough (Mr. Leigh) spoke, Professor Anthony Rudd outlined the 2006 National Sentinel audit results and explained that across England, Wales and Northern Ireland, 226 hospital sites were offering CT scanning, but only 18 per cent. were able to provide scanning within four hours. On weekdays, the vast majority of trusts were able to do a scan within 48 hours, although 7 per cent. could not. However, at weekends, 35 per cent. were taking longer than 48 hours. So scans for stroke patients are being delayed, even though we know that time lost is brain lost in those circumstances.
	At that same conference, Professor Norrving from Lund university in Sweden said that his country had a virtually 100 per cent. delivery rate for CT scans within 24 hours and Professor Bladin from Melbourne, Australia described how all patients at his hospital have immediate access to scanning. Those international comparisons should serve to demonstrate to us what a dramatic difference there is in the quality of stroke care being provided in this country compared with some of the leading examples across the world.

Andrew Lansley: I am grateful to my hon. Friend. I was not intending to dwell on that important point, but the evidence, not least from Stroke Association surveys, is that that public have far too limited an awareness of what stroke is. They have become confused about the issue and perhaps just a bare majority understand that a stroke is a brain attack. Even fewer have a clear understanding of what leads to a stroke. In recent examples, such as the Food Standards Agency's campaign on salt reduction, raising the public awareness of the need to reduce salt intake has been focused on the risk of a heart attack. That is valid, but it was done on the basis that the public did not understand the relationship between salt intake, hypertension and stroke. In fact, in terms of mortality and morbidity, stroke is the greater risk, so we need to work harder on that.
	The quality and outcomes framework for general practitioners rightly includes the management of hypertension, but—as my hon. Friend suggests—many people do not yet know their blood pressure and, in cases in which it is appropriate, are not properly monitored or attempting to address the problem through diet and exercise or even medication. We need to make that happen, because reducing the incidence of stroke must be one of our key priorities. The awareness of stroke and how to prevent it should form part of our strategy, and the NAO made that clear.

Andrew Lansley: I am delighted, on behalf of colleagues on both sides of the House, to welcome back my hon. Friend. I know that he has already been active in his constituency, but we are delighted to have him here. I share entirely his view and we should not forget the many staff working in stroke care who are delivering excellent care. However, we need to be aware of the lack of stroke physicians and services. As the Sentinel audit recently made clear, we have limited numbers of consultant nurse posts and a quarter of hospitals have no specialist stroke nurses available. Those are essential parts of the process of delivering high-quality stroke care. However, I entirely share my hon. Friend's view about the need to match what has been achieved on the Isle of Wight.

Andrew Lansley: I am very grateful to my hon. Friend for making that point. I was about to come to the findings of the 2006 National Sentinel audit of stroke care. The first of its top 10 recommendations is that
	"The Welsh Assembly Government, Commissioners, Managers and Clinicians should urgently address the growing divide in quality of stroke care between Wales and the rest of the United Kingdom. The highest priority should be given to the development of specialist stroke services, both in hospital with full provision of stroke units and in the community."
	I am afraid that it felt compelled to say that the very low rate of stroke unit admission in Wales was unacceptable. My hon. Friend, given his responsibilities, will be pressing for precisely that priority to be given in Wales. It is important for us to recognise that today's debate—from our point of view—is about stroke services in the United Kingdom, not just in England. I hope that the Government hear that message and communicate it to the Welsh Assembly Government. I know that my hon. Friend will do exactly that.
	In looking at the Sentinel audit, I do not want to diminish the progress that is being made, in part, precisely because stroke physicians have been pressing for it. For example, there has been an increase in the number of specialist stroke units in hospitals in England—up to 91 per cent. from 79 per cent. in the previous audit—but only 62 per cent. of patients are admitted to a specialist stroke unit. However, that is an increase on previous figures. There has been an increase in the number of neurovascular clinics, which means that transient ischaemic attacks—mini-strokes, as it were—are increasingly followed up in clinics. However, we need to do more. As I said, there are too few stroke physicians and too few specialist stroke nurses, and only 22 per cent. of hospitals have an early supported discharge team.
	One central issue in the development of stroke care is acute care—treating stroke as an emergency. Here, I pay tribute to the Stroke Association, which ran a campaign entitled "Stroke is a medical emergency" and uses the FAST protocol—the face arm speech test protocol—developed by Gary Ford and his colleagues at Newcastle university. The publishing and dissemination of such developments across the country is a vital part of raising awareness of the fact that stroke is an emergency.
	Of course, we must not allow the situation to arise whereby, when stroke symptoms develop, they are identified, an ambulance is called for and it takes the victim to an accident and emergency department, only for time simply to pass and brain function to be lost. We must take urgent action to ensure that that does not happen. I have been involved in the all-party group on stroke, of which I am now chairman, since its inception in early 2003, and we have argued for the taking of such action since early 2004. The protocols and structures required have become increasingly clear; indeed, on visiting other places throughout the world—the NAO visited Australia—one can see precisely how they can be achieved.
	The Sentinel audit tells us how far we have come. In Australia, after immediate CT scanning, all those patients for whom thrombolysis is appropriate get access to it. About 10 per cent. of stroke patients get such access. According to the audit, however, in the preceding year 218 patients in this country were thrombolysed, representing 0.2 per cent. of all such patients. That is an enormous disparity. Some 18 per cent. of hospitals in this country still have no specialist acute stroke unit, and only 10 per cent. of hospitalised stroke patients are admitted directly to an acute stroke unit.
	Those two elements are central: patients should be admitted directly to a unit capable of undertaking immediate CT scanning; and, where appropriate they should undergo thrombolysis. In any case, such patients should be admitted directly to specialist stroke units, and should in virtually all cases spend their time in hospital in such a unit. We have known about these issues for some time, but we have by no means made sufficient progress on them. The NAO report was clear on the benefits that could accrue from treating such cases as emergencies.
	The point was brought home to me some three or four weeks ago, when I attended the memorial service for Sir Arthur Marshall. After the service, a gentleman named Ivan came up to me and said, "You're interested in stroke and involved in Westminster's all-party group on stroke—I'd like to help. I used to work at Marshall Aerospace, and I woke up one night a year or so back and I couldn't speak, couldn't feel anything and couldn't move the left side of my body. I was taken to Addenbrooke's hospital"—Addenbrooke's is in my constituency—"and I had a CT scan straight away and I was thrombolysed." Presumably, he is one of the 218 patients to whom I referred earlier. I looked at him and said, "Well, it's clearly gone very well." The extent of his subsequent loss of brain function is that occasionally he has pins and needles in his left hand. Previously, he would probably have had full left-side paralysis. So, dramatic differences have been made, and we need to be aware of the scale of what we can achieve if we take such steps.

Andrew Lansley: I am very happy to share my hon. Friend's support for the air ambulance service, which also plays a central role in parts of East Anglia. As I drive into Exeter, I always note the shop that the service has there. Perhaps I will stop next time I pass it, in order to support Devon air ambulance. The fundraising for the service provides a dramatic benefit. The health service supports the paramedics and the other medical and clinical aspects of the service, but putting the helicopter in the sky and maintaining it is funded entirely from voluntary support.
	The NAO report makes certain things very clear. For example, it estimates that admitting stroke patients to, and treating them in, a stroke unit could save up to 550 lives. It says that transient ischemic attacks should be followed up rapidly in a clinic, given that there is a 20 per cent. risk of a stroke immediately following a TIA. Such action can forestall and prevent major strokes. For many patients who suffer from artery occlusion, sclerotic artery surgery produces benefits within 14 days. Interestingly, the PAC and the NAO identified that such changes, which would substantially improve outcomes for patients, would not cost the NHS more. If all those measures were implemented, there would be an overall saving to the NHS, not an additional cost. The aim is a change in the design of services, and to get the NHS to respond by prioritising service delivery, which would be better for patients and better for the NHS in value-for-money terms.
	Where do we go from here? One purpose of the debate is to raise the profile of the issue of stroke. Another purpose was to try to make sure that the Government publish their consultation on a national stroke strategy before the House rises for the summer, but I am delighted to say that the Secretary of State did that on Monday, which means that we can debate it. Happily, plenty of Opposition Members are present, and a few Labour Members are too, but I hope that more colleagues are listening to the debate, or will read it.
	I want to encourage colleagues in all parties to include in their constituency engagements a visit to their local hospitals to talk about the stroke services that are provided. In addition, I hope that hon. Members with a branch of the Stroke Association in their areas will talk to its members—for myself, I am patron of the Stroke and Dysphasia Association in Cambridgeshire. We should all make sure that we have conversations with everyone involved over the next three months, as the consultation on the national stroke strategy ends on 12 October, which means that the scope will be limited when we return after the recess.
	I welcome the Government's publication of the document "A New Ambition for Stroke". Clearly, it was a very inclusive process, and many of the people I know to be leaders in the field were engaged in the working groups that led to the document. It is very important that the Government show that a priority is now attached to stroke. Unfortunately, a top-down system such as the NHS needs to show top-down priority, so it is important that the Department of Health has published a document.
	I do not want to be at all churlish but, although the document published on Monday sets out very well the sort of ambitions that we must have for a stroke service in the future, there were few surprises or novelties on top of what the National Audit Office produced 20 months previously. I am therefore slightly at a loss as to the purpose of having a consultation on a national stroke strategy now, given that the document makes it clear that the Government know what they think the stroke service should be like. As I understood it, the Government's document was intended to turn the NAO recommendations of 20 months ago into an action plan. It was supposed to show how we should get from here to there, but in many respects the document that has been produced does not achieve that.
	As some of my hon. Friends made clear earlier, the availability of CT scanning is absolutely fundamental. Does the national stroke strategy make clear how, for example, diagnostic contracts and the like will be used to ensure that CT scanning is available 24/7? The strategy presents the model of a hub-and-spoke system, as we always knew it would, but its parameters are still too wide. For instance, we need to be clear about the scale of population to be covered by such a system, and the length of time that people will stay in each hyper-acute stroke unit. We also need to be sure that such questions are followed up in individual locations.
	A month ago, Manchester started work on producing its local service plan. The document that has been produced there says that patients admitted to a hyper-acute stroke unit should be scanned and given immediate treatment—including thrombolysis, if necessary—and also be given access to the earliest possible rehabilitation. However, what is interesting is that the document suggests that people need spend only 24 hours in such a unit. I have visited many places across the country, and talked to a lot of senior managers. They tend to imagine that creating better acute care for stroke sufferers will involve concentrating stroke units into larger units at specialised hospitals. In contrast, the people in Manchester have not adopted that approach. Instead, they seem to be saying that the hyper-acute phase needs to be concentrated, but that patients should be referred back to their local hospitals 24 or 48 hours later; each such hospital should have a specialist, multi-disciplinary stroke unit, where hospital treatment can be concluded and people discharged early.
	That is different from the approach adopted by many in the NHS around the country. Sir Ara Darzi's report, "Healthcare for London: A Framework for Action", does not appear fully to have taken on board the thinking in Manchester, as it continues to propose a limited number of specialist stroke units in a limited number of specialist hospitals. That does not have to be the structure at all.

Andrew Lansley: I am grateful to my hon. Friend, as he has illustrated very well the point that I hope I was making. His intervention leads me to the related point that a critic of the national stroke strategy would want to make sure that the incentives and levers available are being used to deliver the standard of stroke care that we want to achieve. For some time we have argued that unbundling the tariff—that is, dividing the acute phase from the subsequent rehabilitation phase—is important. The Department of Health has done that, but the structure proposed in Manchester would require dividing the tariff into three phases: the hyper-acute first 48 hours, the subsequent initiation of rehabilitation and support, and then rehabilitation in the community.
	The tariff is anything but clear about how it will support and incentivise the process of commissioning. Unfortunately, if it does not reflect the best possible standard of care, it can substantially inhibit the introduction of such care. For example, a manager at Kingston hospital told me that his hospital wanted to be able to provide acute stroke care in the form advised, but that the tariff did not support that. We therefore need to concentrate on the tariff: although I hesitate to talk about something that can be a preoccupation for NHS anoraks, it is very important that we get it right.
	The document "A new ambition for stroke" contains many elements that read extremely well and are clearly the right things to do, but one or two criticisms remain. For example, GP protocols for the referral of patients after a transient ischemic attack were set out first in the national service framework for older people in 2001. They were supposed to be implemented across the country by April 2004, but now they are being repeated in a document published in July 2007. It is not good enough for policy makers to publish documents which reiterate the standards of service that we want to achieve but find that progress is inadequate and that the available levers to ensure that those standards are achieved are not being used.
	Obviously, the Secretary of State cannot add very much to a document that he published on Monday, but his foreword says that it is the "first step" to a national strategy. It is not the first step—it is about the 13th, and we need the strategy to be turned, rapidly, into action. I have talked to ambulance service staff across the country, and they know that in a few months they will be delivering emergency patients in acute need to hospitals. That is already happening in some places, but it will be no good if the NHS fails to treat patients as emergencies from that point onwards. The evidence is absolutely clear that such patients must be treated in specialist units, and that subsequent support by multi-disciplinary rehab teams in the community is vital.
	Too often, stroke patients tell us that they feel that going out into the community is like falling off the edge of a cliff. They leave a supported service in a hospital context and move to a place where the social services and the NHS services do not join up and the necessary teams do not exist. From the Healthcare Commission's report, we know that six months after leaving hospital 50 per cent. of patients feel that they are not getting the standard of care they should, and that 12 months afterwards the number has risen to 80 per cent. Half the stroke patients who want to be involved in a local support group are not; 28 per cent. feel that they are not getting help when they need it to deal with mobility problems; 49 per cent. do not receive help with emotional problems when they need it; and 26 per cent. feel they are not given help with speech problems when they need it. It is tragic that large numbers of physiotherapists and speech and language therapists cannot find jobs in those services when they leave college, even though we know there is a specific need for them to provide such therapy for stroke patients. Their participation is needed in community multi-disciplinary teams.
	At the risk of borrowing a phrase, the purpose of the debate is to say that a lot has been done, but there is a lot more to do.

Alan Johnson: I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:
	"commends the dedication and energy of the doctors, nurses, therapists and other professionals working tirelessly to help the 110,000 people affected by stroke each year; notes the significant recent progress made in stroke care with falling premature mortality rates and more people treated in stroke units than ever before; further commends the work of the National Audit Office, the Committee of Public Accounts and the All-Party Parliamentary Group on Stroke in scrutinising progress on stroke care and recommending further improvements; welcomes the opportunities offered by new treatments and the growing evidence on effective rehabilitation; celebrates the investment of £20 million in the UK Stroke Research Network to help ensure stroke medicine fit for the 21st century; further welcomes the additional training places made available in stroke medicine; further welcomes the new guide and tools available to support improved commissioning of stroke services; thanks the Stroke Association, Different Strokes, Connect, the Royal College of Physicians and over 100 individuals for their work in developing proposals for a new stroke strategy; and commends the consultation document 'A new ambition for stroke.'."
	I start by paying tribute to the hon. Member for South Cambridgeshire (Mr. Lansley) for his work over many years, both in a personal capacity and as chair of the all-party stroke group, in raising awareness of the terrible impact that strokes can have upon individuals and their families. He was kind enough to point out that we pay tribute to his work in our amendment, but he rather modestly neglected to mention the all-party group in his motion. I welcome the spirit in which the hon. Gentleman opened the debate. This is an issue where parliamentarians can get together to move things forward. There are many such subjects in health, but this is one of the most important on which we need to find consensus.
	On behalf of Members on the Government Benches, I echo the hon. Gentleman's welcome back to the hon. Member for Isle of Wight (Mr. Turner). We have missed him since December and are pleased to see him back looking so fit and well.
	Every year, 110,000 people in England have a stroke, which is one every five minutes, so given the time available for this debate, between 15 and 20 people could have a stroke during its course. With 50,000 deaths, strokes represent the third biggest killer after cancer and heart disease—killing three times as many women every year as breast cancer. Strokes are the greatest cause of severe disability. More than 300,000 adults in England suffer lasting disabilities as a result of a stroke. The cost to our economy runs to billions—but that is, of course, immaterial when set against the terrible turmoil that befalls survivors and their families, whose lives can be devastated, literally overnight, by such attacks.
	I disagreed little with the comments of the hon. Member for South Cambridgeshire; his analysis was right, in terms of both the debilitating nature of strokes and, more important, the need to give stroke prevention and care much greater attention and priority. It is true that the Department of Health has focused particularly on cancer and heart disease, which are the country's two biggest killers, and we have made huge progress. Cancer deaths are down by 15.7 per cent. since 1997, saving more than 50,000 lives; while cardiovascular deaths are down by almost 36 per cent., saving almost 150,000 lives.
	At the same time, attention has been paid to the third major killer. In 2001, as the hon. Gentleman mentioned, we published the national service framework for older people, pledging that every trust in England would have a specialist stroke service—a necessary target that has been achieved. We have also helped to improve standards. A recent study by the Royal College of Physicians showed that 95 per cent. of stroke units now have most of the necessary elements for a good quality service, compared with just 72 per cent. in 2001. Our efforts to improve public health—on smoking, fitness and obesity—have played a vital role in our quest to reduce the number of strokes. Since 1993, deaths from strokes have fallen by 30 per cent. for over-65-year-olds and are down by 23 per cent. for those under the age of 65.
	I fully accept, however, that there is more we must do to remedy the failings highlighted in the reports by the National Audit Office and the Public Accounts Committee. We are able to build on strong foundations. We now possess far greater knowledge about lifestyle factors and how they can cause strokes than we did 10 years ago. We have learned more about techniques in rehabilitative long-term care and how acute care can be managed in the community. Technology has advanced considerably, particularly for brain imaging and scanning, so we can now dramatically reduce the number of people killed or left severely disabled by a stroke. Through greater investment and reform, the NHS infrastructure is now equipped to provide the rapid response reactions that strokes require.
	In response to the NAO and PAC reports, Professor Roger Boyle, the national director for heart disease and stroke, produced an excellent report, "Mending hearts and brains". I point out to the hon. Member for South Cambridgeshire that it is a consultation document to enable us to arrive at a strategy, and I shall take his comments into account as part of the consultation. Yes, there are issues in respect of tariffs that we have to tackle, and the all-party group has raised many issues that are not fully covered in the text of Roger Boyle's report, but the document turns an NAO-PAC issue into something that has had input from a vast variety of physicians, as well as from discussions with the Stroke Association and other voluntary groups, so that we could present it before we arrive at a final strategy by the end of the year.
	After detailed follow-up work by Professor Boyle and his six clinically led specialist project groups, my Department published a draft stroke strategy. I take this opportunity to thank the many leading clinicians and voluntary sector organisations who took part in the project groups, especially the Stroke Association, Connect and Different Strokes. I hope that Members on both sides of the House will give the document careful consideration and take the advice of the hon. Member for South Cambridgeshire to use the impending recess to contribute fully in their constituencies so that we can produce a final strategy by the end of this year.
	I do not believe that improving our performance in this area is related purely to funding. As the hon. Gentleman said, England spends more on stroke services than many other nations, both in absolute terms and as a share of total health spending, and yet we do not get the best results. Many hospitals and primary care trusts, such as King's College hospital, which I visited on Monday, are already achieving great things. We know that clot-busting thrombolytic drugs can make the difference between someone who has suffered a stroke leaving hospital on their feet or in a wheelchair. However, overall in England last year, a tiny percentage—less than 1 per cent.—of patients received thrombolysis. King's has already achieved rates of 18 per cent. this year. The hon. Gentleman referred to Australia, which is achieving 10 per cent. As a result of a dramatic reconstruction along the lines suggested in the consultation document, Ontario is now achieving 37 per cent. thrombolysis, which is up from 3.2 per cent. just four years ago.

Alan Johnson: Yes, it is absolutely essential that we do that. I will come on to say something about that when talking about the report. That is obviously a mismatch. I believe that Professor Roger Boyle says in his report—he certainly said it to me—that the whole stroke area is where heart disease was 10 years ago. We need to bring it up to today's levels, particularly in terms of the number of consultants and clinicians who specialise in the area. The key to success will be ensuring that more people do the right things at the right time at all stages of the patient pathway. Strokes, perhaps more than any other illness, are time critical, so speed is of the essence.
	There are three elements to the consultation report. First, there is prevention. Historically, strokes have been a poorly understood condition. They are inevitably linked to the over-65s and to old age. In the past, the fatalistic approach was to wait until a stroke occurred and then deal with the consequences afterwards—at great personal cost to the victim and incidentally greater expense to the health service. About one in four long-term beds in the NHS are occupied by stroke patients.
	Some strokes have genetic causes, but many people suffer needlessly because they do not recognise that they are risk or know what they can do to lessen that risk. Early action can help to prevent many strokes. We must ensure that better co-ordinated support is available for those at risk so that they are encouraged to monitor their blood pressure and cholesterol, take regular exercise, stop smoking and reduce their salt intake.
	We must refute the myth that strokes affect only older people. One in four victims is under 65. We must also promote awareness among communities that are most at risk. People from African, Caribbean or south Asian backgrounds are twice as likely to suffer a stroke as the rest of the population. We have already funded some pilot publicity campaigns, together with the Stroke Association, and will look very carefully at the results.
	Some people do not know how to recognise the symptoms of a stroke, either in themselves or in others. That can prove tragic when someone has suffered a minor stroke—known as a transient ischaemic attack or TIA. TIAs indicate a serious problem: part of the brain is not getting enough blood. Without treatment, around one in four people will go on to have a full stroke—most within the following few days. Provided that people are aware of that, it can be prevented—sometimes with something as simple as aspirin and sometimes with an operation to unblock the arteries in the neck. We need a radical transformation of attitudes and actions to prevent strokes from occurring. The consultation document sets out an ambitious new vision: people who are assessed as being at high risk of a stroke should be seen by specialists and scanned within 24 hours.
	Secondly, we must ensure that there are quicker emergency treatments for those who have suffered from a stroke. Advances in technology mean that we can dramatically reduce the number of people who die or are left with severe disability after a major stroke—again, provided we get to them quickly enough. There is a window of only three hours in which patients must be seen, scanned and treated. With 2 million neurons lost for every minute of delay, we need a much faster pathway to treatment, as identified in Professor Boyle's report. With all paramedics properly equipped to identify the patients in greatest need and proper specialist care readily available, we can resolve the problem.
	On Monday, I saw the impressive speed with which people were moved from the accident and emergency department to a stroke unit at King's, having been seen by a specialist and given a scan on the way. Professor Boyle says that if strokes were treated as emergencies, more than 1,000 stroke victims every year would regain independence, which makes a compelling case for reconfiguring acute services to ensure that highly specialised care is concentrated at centres that can offer round-the-clock expertise.

Alan Johnson: That is interesting, as was the view expressed about Manchester. King's has a triage nurse in the accident and emergency department. I guess that, in effect, the system means that someone is in the stroke unit as soon as they come in, although it happens to be located in a different place. The philosophy is to get people through the system as quickly as possible, making sure that scans are available and that TIA is taking into account if appropriate. Having specialists available 24 hours a day, seven days a week is the key issue at King's and other such centres.
	We should also look at improving ambulance response times. We are consulting about upgrading strokes from category B to category A events so that ambulances arrive within nine, rather than 18 minutes.
	Thirdly, we must ensure that there is better aftercare for those who have suffered strokes. The best way to improve care for such people is by engaging with them and ensuring that they feed into the consultation, which is why we have produced an easy-to-read version of the document for stroke survivors who have communication difficulties. Often, stroke survivors say that they wish to be at home during the rehabilitative stages. Early supported discharge schemes get people home quicker, provided that there is better rehab care available.
	Recovering from a stroke can take many years. Our strategy needs to ensure that the NHS is able to remain on hand, helping patients to gain increased independence, with enhanced support available from local specialists, providing them with action plans and progress reports. There is still a huge gap between the number of cardiologists and the number of stroke specialists, as was mentioned in an intervention. We need to increase the work force capacity to resolve that and we have already worked with the Stroke Association to fund an additional three specialist posts. We will invest in training 10 further specialists this year alone.
	Having brought about huge reductions in cancer and heart disease, we must now promote the treatment of strokes to become our top priority. In the 1970s, England was the heart disease capital of Europe, but that has changed. We can, will and must ensure that a similar transformation takes place in this area. With record investment, new technologies and health professionals who are already gearing up to tackle this challenge we will succeed, thus truly transforming the lives and prospects of thousands of people and their families who are affected by this debilitating condition. I commend the amendment to the House.

Sandra Gidley: Well, I was going to start on a positive note.
	According to a recent audit by the Royal College of Physicians, the death rate from stroke in a range of age brackets has fallen by approximately a third, which must be good news. Well over 90 per cent. of English hospitals now have a dedicated stroke unit. The vast majority of health boards and NHS trusts have achieved their targets, and stroke registers have been established in more than 60 per cent. of GP services.
	Now comes the "but". We have heard about the problems caused when stroke patients who are admitted to hospital receive insufficiently rapid access to a stroke unit. I shall outline problems all along the patient pathway later, but there are general problems that have a great impact on stroke services. For example, people have difficulty accessing therapists and social workers. Although we are training loads of physiotherapists, we are not deploying them where they could benefit patients. It has been pointed out that the tariff for supporting stroke patients is inappropriate and there is no financial incentive for hospitals to provide stroke services subsequent to initial treatment. Most importantly, there is little public awareness of the problem. A quarter of hospitals have no form of senior stroke nurse specialist, yet the national clinical guidelines on stroke say that specialist stroke services should be available in the community as part of an integrated system of care to facilitate early supported discharge.
	The new Health Minister who will sit in the other place recently had something to say about stroke services. In May, he pointed out that of the 30 hospitals in London providing stroke services, only four treated more than 90 per cent. of patients in a dedicated unit. He said that while patients should receive a CT scan within three hours, 90 per cent. of patients received a scan within that time in only seven out of 30 hospitals.
	The number of patients receiving clot-busting drugs has been highlighted. My immediate assumption was that the situation was due to a lack of resources, but as hon. Members have pointed out, "A new ambition for stroke", which the Department released on Monday, rebuts that because, importantly, Professor Roger Boyle states:
	"As a nation we spend more money than most on stroke services—and a greater percentage of our health budget—yet, overall, we have worse outcomes."
	That raises serious questions. Given that the money and the national service framework for older people have been in place—a whole chapter of the NSF is dedicated to stroke services—what went wrong, and why was the money not targeted properly? We have hospitals such as King's that provide a brilliant service, so why have stroke clinicians and workers in other parts of the country had difficulty getting together and achieving the same sort of outcome? Have they been blocked by hospital management, or was there no initiative on the ground? If we are to move forward positively, it will be worth considering such basic questions to determine what has happened and how we can learn from the mistakes that have been made.
	The problem with the NSF for older people was that no funding was attached to it. Perhaps money was in the system, yet people did not know how to access it. I surveyed several PCTs to determine whether stroke targets were being met. It was clear that a number of proactive people had used the NSF as a lever to get local health commissioners and PCTs to go a little further. Such a thing can be done, but we need to learn why that has not happened in many cases.
	The real tragedy is that, according to the Stroke Association, approximately 80 per cent. of strokes are preventable. I am pleased that several Health Ministers are in the Chamber. It would be nice to have official notice of which Minister is responsible for public health and their specific responsibilities —[ Interruption. ] I welcome the Minister of State, Department of Health, the right hon. Member for Bristol, South (Dawn Primarolo), to her job. It is difficult when people do not quite know which Minister to go to about what.
	The public health aspect of stroke is important because there are many simple steps that can have an impact on outcomes relating not only to stroke, but to heart disease and cancer. According to the National Stroke Association, about 20,000 strokes a year could be prevented if health professionals and the public gave sufficient attention to awareness of people's blood pressure, determining whether people have a normal heart beat, and stopping smoking. Other steps that can be taken are the usual culprits in messages on public health and healthy living: cutting down on alcohol, keeping cholesterol under control and following a healthy diet. It has been proven that simple things such as eating more fruit and vegetables can reduce people's risk of stroke. I hope that greater emphasis will be given to such messages.

Sandra Gidley: I notice that the programme was aimed at children, among whom the rate of stroke is low. I understand the Secretary of State's point about establishing healthy eating patterns, but I would like to know whether the meals were being eaten, because if healthy meals are not eaten, we have to look at the problem in a different way. If he sends me more details, I will follow that up.
	Exercise is another factor. It is worrying that only 37 per cent. of men and 25 per cent. of women meet exercise guidelines. Even moderate activity can reduce the risk of stroke by up to 27 per cent. As has been suggested, people need to recognise the symptoms of stroke, so a public awareness campaign is needed. It is obvious when someone has had a full-blown stroke, but TIAs can result in minor symptoms. Patients who have had a TIA need to be examined by a doctor, because if they are treated properly we can reduce the overall impact of stroke.
	We see the problem when we look at the timeline. A patient will first seek a GP appointment. The good news is that patients are supposed to be able to get an appointment within 48 hours. Although there can be problems if people do not ring their surgery at a certain time of day, access to GPs has generally improved. However, if a patient is not aware that their symptoms could be serious, they might write them off as something not worth worrying about.
	There can be a lack of awareness of the matter among GPs. Even among GPs who are aware of the symptoms, a fifth do not refer TIA patients for further investigation, as was revealed in a recent survey. There have been attempts through the quality and outcomes framework to improve the situation, but things do not seem to be working at the moment. Only 55 per cent. of GPs say that they would refer TIA patients immediately.
	If a patient is referred, there can be delay in accessing a clinic and getting the requisite tests. Only a third of people with TIA are seen in a clinic within 14 days, but the recommended time set out in most clinical guidelines is seven days. Attention is being given to improving patient pathways, but I hope that the obsession with the 18-week target, which in itself is a good thing, does not mean that attention is diverted away from the seven-day target, which also needs to be reached.

Sandra Gidley: I understand that the hon. Gentleman has not been here for the whole debate. I do not know whether he was here for my opening comments, but his point was acknowledged: some places are beacons of excellence, and we should work towards ensuring that their standard applies in all places. If he has an excellent service locally, he is one of the lucky ones.
	To return to the subject of the clinics to which patients who have had a TIA are referred, many of them are now run as one-stop shops. That can be a good thing, but sometimes, once tests have been performed, there is a delay in communicating the results to the GP. That is another part of the pathway that needs looking at. If attention is paid to the pathway, there is a strong chance that we will significantly reduce the number of people who have to call an ambulance because they have had a stroke. I, too, pay tribute to the Stroke Association for its campaign to have stroke treated as a medical emergency. In Hampshire, all the hospitals, the ambulance service and community nurses are working together to try to ensure that services are much more joined-up. They also work with groups that come into contact with patients soon after they have had a stroke, including St. John Ambulance and the Red Cross, to make sure that they are aware of the FAST campaign.
	People have to recognise that they have had a stroke, and that can be a problem in itself. More public awareness would be helpful. Once the patient's condition has been recognised, there is still the problem that only 10 per cent. of hospitals have a system, like that at King's, which enables thrombolytic drugs to be administered quickly enough. As that system saves lives, we should really focus on it when considering how we can improve our services.
	The clinically optimal model for stroke care is for care to be delivered in a specialised stroke unit, but we need clarity about what a stroke unit is. That might sound an odd question, but many stroke units have a high proportion of rehab patients, and a relatively small proportion of their resources are used to treat patients in their first couple of days in the unit. All the evidence seems to show that treating patients early delivers much better outcomes, so in many hospitals it may be a case of shifting attention or of providing slightly more resources for treatment at the earlier stage, because when the impact of the stroke is minimised, the long-term costs are reduced. According to Professor Boyle, that would make financial sense.
	The hon. Member for South Cambridgeshire mentioned problems accessing scans—sometimes, people may be unlucky if they have their stroke at the weekend. The provision of stroke services is very much a lottery. In some parts of the country, systems are in place, everything works well and the process is smooth, so people in those areas will have a good outcome. In other parts of the country, the process is not so joined-up, and that is where joined-up working is really needed.
	I want to talk about aftercare. A third of acute stroke patients are left dependent or moderately disabled and our aim must be to reduce that figure, and taking some of the steps outlined earlier in the debate would make that possible. During their hospital stay, patients have access to help and care, but when they go home, they must suddenly readjust their lives. Figures for south London show that only 26 per cent. of patients in need received physical and occupational therapy, and 14 per cent. received speech and language therapy, three to 12 months after discharge. If an individual cannot do the things that they are used to doing, or cannot communicate properly, it is very frustrating for them. That leads to problems with depression, and to problems for other people in the house who have to adapt to the condition, too. We have a network of local stroke clubs that do excellent work in helping people to feel that they are, in many ways, once more part of society, and I pay tribute to them.

Sandra Gidley: I appreciate the hon. Gentlemen's problem. Some of our local clubs are well-funded by the people involved, but I appreciate that in other areas of the country that arrangement is not feasible or practical. Anything that helps the rehabilitation process should be considered. Often, there are rooms available that are not being used, and they could be used for such purposes. I ask that attention be given to aftercare. Perhaps we could use more therapists; we should consider carefully whether more of them will be needed for the future. The Select Committee on Health recently produced a report on work force planning, which highlighted the fact that there does not seem to be much in the way of such planning. The recent example of the training, and lack of recruitment and use, of physiotherapists highlights the problem. We also need to assess how much occupational and speech therapy we will need in future. We must ensure that people have access to those services, so that they can live a full, proper and useful life.

Ian Gibson: May I welcome the Front-Bench team to the debate? It is nice to see them. I have not spoken with, or against, the Secretary of State for Health since the debate on top-up fees; I had fond memories while I listened to this debate.
	An exhibition is on at the Wellcome Trust's science foundation on Euston road. It is about all parts of the vascular system—the heart, veins, arteries and so on—and it takes us right from the day when William Harvey first showed that blood coursed around the body through arteries and veins. We have to remember that there was a time when people did not understand that; we have come such a long way since.
	I suffered a mini-stroke some three years ago, a month after I played Kenny Dalglish off the football field as part of the parliamentary team; I remember that well. It showed that strokes can happen to people who are fit and lively and that people do not see them coming. I did a lot of things that I should not have done; I say that now that I know first-hand what a stroke can look and feel like. After a hectic, busy week, in which I remember voting in the House on fox hunting, for the 20th time or something like that, I dashed off to Tel Aviv. I travelled overnight and had no sleep, and then I found myself out in Gaza with the Secretary of State for Innovation, Universities and Skills, my right hon. Friend the Member for Southampton, Itchen (Mr. Denham). We were shown around, and at night we dined and sang a few Irish songs; it was quite a jolly occasion. I went to bed wobbling a little, but I knew that that was not down to drunkenness. I absolutely knew what the problem was, but I thought, as all men do, "I'll sleep it off, and then I'll be okay again." The next morning, I had a little problem shaving and so on. I phoned up my right hon. Friend, and then the fun really started.
	I remember that we were in Ramallah at the time and were heading out to visit the Gaza strip. There was a bit of a hoo-ha—a fight—about which ambulance I should travel in. I instinctively wanted to be in a Palestinian hospital and ambulance, for various political reasons. We went through several checkpoints with guns pointed at us, and I was taken out of the Palestinian ambulance and stuck into an Israeli one. I have never seen anything like it—when we went into the Palestinian hospital at gunpoint with Israeli soldiers, the whole accident and emergency department emptied immediately.
	The treatment was amazing, with an immediate scan, although we had probably taken about four hours to get from the hotel, through the checkpoints and so on. It was marvellous to meet UK surgeons who had given up their holidays to work with young people with heart problems who came in from the Gaza strip. The House can imagine the difficulties that that causes. We are fighting hard to get a heart unit in that Palestinian hospital because those surgeons still go out there.
	I take the opportunity of this gentle debate to say something about the subsequent treatment and what happened at the Norfolk and Norwich university hospital, which does not always win plaudits. It was one of the first PFI hospitals and it takes a lot of knocks, but the service is amazing, particularly in the stroke unit. I speak to the consultants quite often. I was lucky, given the delays in my treatment.
	Norfolk and Norwich university hospital's excellent 36-bed stroke unit was set up in 2002. It services about half a million people in the Broadland district, Norwich and south Norfolk. Before it opened, patients were scattered in various surgical wards. In the short time it has been open, the unit has brought them all together and it offers language therapists, physiotherapists and specialist nurses.
	The unit has a great record for treating TIAs—mini-strokes. Major strokes after TIAs are quite likely in a small percentage of cases. They are medical emergencies and should be treated as such, just like an acute coronary syndrome of some sort. Immediate, co-ordinated care, is essential on those specialist wards, and I am pleased that we have such a unit in Norwich. It is ambitious, and I shall speak about its plans.
	Access to the unit and assessment is an interesting point. I welcome the Secretary of State's recommendations in "A new ambition for stroke". We have some fantastic services in the UK, and that will add to them and to the one in Norwich, in particular. It is time to build on our successes. Stroke must be treated fast. Time is of the essence, and the document highlights the fact that the fastest access to treatment will lead to the greatest success.
	Like most hospitals, Norfolk and Norwich university hospital admits stroke patients via their GP or accident and emergency, so patients may be assessed several times before they see a stroke specialist. An experiment is being conducted at Edinburgh university, where the specialist stroke nurse carries a portable phone and exchanges information with those in the ambulance. Attempts are being made to staff ambulances with people who understand strokes and can diagnose and even treat them immediately by administering drugs. The nurse at the hospital can be ready for the specialist process of stroke triage and can administer the first line of defence—clot-busting drugs—and arrange for CT scans before the patient arrives. About 30 patients have been through the procedure, which is highly successful. The experiment, which involves no great expense, is just a better way of doing things.
	Other research programmes are under way at the hospital. At present it is thought that stroke treatment must be administered within three hours. An international stroke trial is investigating whether that period can be extended.
	I am very involved in stem cell research, and I declare an interest as a member of the UK Stem Cell Foundation, which Sir Richard Sykes chairs. Another member is Sir Richard Branson. If one knows the right people who are interested in this area, it is possible to collect £90 million overnight, from great champagne merchants and so on. We are trying to induce the Medical Research Council to talk to us about conducting joint experimentation and joint assessment of treatments. I think that that will eventually work out, after a few initial problems.
	Stem cells seem to migrate to the damaged part of the brain, which is interesting because it might repair some of the cells. There is great hope that stem cells might be one way forward. That is why I am so pleased that the House has passed legislation, which has proved difficult in other countries.
	Work is also being done on atrial fibrillation irregularity—the abnormal heart rhythm that the previous Prime Minister, for example, had. That can often increase the risk of stroke. Much exciting work is going on in the UK. We are examining the effects of increases and decreases in blood pressure. Amazing rehabilitation work has been done. I missed only one day of work after my mini-stroke, but I went to the rehab unit to see how it worked. Amazing treatments are available, both in hospital and in the community, depending on the patient's requirements.
	Some of the drugs that have been invented, many of them in the UK, are essential to help people get through the difficult periods. Warfarin, for example, and statins are often used. I bet that at least 80 per cent. of the Members of the other place are on statins and do not talk about it. I know quite a few people who are, and there is nothing wrong with that. Whether statins need to be made so widely available is a matter for debate, but they are handed out to try to prevent heart or blood problems of some sort.
	Yesterday afternoon the unit at Norfolk and Norwich hospital presented to the PCT new plans for better services in ambulances and for educating people. Many people still do not know the difference between a stroke and a heart attack. There is a great deal of confusion about that.
	I have mentioned the multidisciplinary nature of the unit's work. The people involved are passionate about their work. The unit works with a unit for older people, and the combination of services, which is a small initiative, seems to help to produce results. The system will be a roaring success with such dedicated, highly trained people working in those units. Much good work is being done but much more, as we have heard, is still to be done. With the services of the scientists and medics in this country, we are just about world class. When we have the debate next year, I think the Opposition will have to admit it.

Hugo Swire: I join in the universal gratitude in the House at seeing my hon. Friend the Member for Isle of Wight (Mr. Turner), who has just absented himself. He is the living evidence that with the right medical care and the right mental attitude, one can recover pretty quickly from a stroke. It is great to see him back.
	The word "stroke" is perhaps the wrong word to describe a terrible affliction. It afflicts people in different ways, and some doctors now refer to it instead as a brain attack, which better conveys the severity of it. It is a cruel and tragic affliction, and I very much welcome what we have heard about the change in perception of sufferers. Most European countries rightly regard strokes first and foremost as a neurological condition rather than as an older people's condition, but we still have a considerable way to go in trying to raise awareness. Three times more women die of strokes than of breast cancer each year. When one thinks about the excellent publicity generated about the appalling disease of breast cancer, it is clear that strokes have not had the same attention to date.
	I want to make a couple of points about the need for speedy medical treatment and the importance of suitable rehabilitation facilities. I am extremely glad that the Minister, the hon. Member for Exeter (Mr. Bradshaw), who is now also Minister for the South West, is in his place, because he will no doubt wish to support me in what I say about many of our local facilities, some of which are in his constituency rather than in mine.
	My first point concerns the need to get patients and stroke victims to a place where they can be assessed and treated as quickly as possible. I alluded earlier—the Minister was not here at the time—to the incredibly important work of the Devon air ambulance service, which can get people from any part of the county into a hospital within about 15 minutes. It would be most welcome if Ministers at least acknowledged the work of air ambulances, which are funded entirely by voluntary contributions, and perhaps looked at how they can be supported in the longer term. Air ambulances are enormously expensive to run and maintain. Other charities in the county will say that it is more difficult for them to raise money because Devon air ambulance requires so much, but if one lives on Dartmoor or Exmoor or in more rural areas of our part of the world, one is very glad to know that it exists.
	There is a difference in the statistics on the treatment of stroke victims in the county. Torbay and Newton Abbot hospitals in south Devon have won awards for their stroke treatment. It is interesting to note that on average they CT scan 60 per cent. of their stroke victims within 24 hours. Royal Devon and Exeter hospital, which is in the Minister's constituency, scans only 30 per cent. of its patients within the first 24 hours, although it is in the upper quartile for stroke care. That postcode lottery is simply not acceptable. We need some assurances that the Minister will look closely at seeing how that disparity can be erased as quickly as possible.
	Secondly, I want to talk about the shortage of acute stroke units. In my own constituency of East Devon, there is no acute stroke unit, just an eight-bed rehab unit in Budleigh Salterton. There was talk of having another one in Honiton, but that might not now happen, despite the fact that the county has a higher prevalence of strokes, at 2.8 per cent., than the national average of 1.57 per cent. My hon. Friend the Member for South Cambridgeshire (Mr. Lansley) said that only 22 per cent. of hospitals have early support discharge teams. We need to consider that carefully in terms of Devon's provision. Does the Minister agree that an average wait of between five and 24 hours for a CT scan, rising to 25 to 48 hours at weekends, is unacceptable, given that CT scans offer the best chance of a successful rehabilitation?
	Rehab is incredibly important. I should like to cite the example of a constituent who has come up against the postcode lottery of the current system. Adam Giles-Wilson has been in contact with me since as far back as April, and I have been trying to help him to sort out his problems. I cannot put it better than the words of his original letter to me:
	"I had a 'massive' brain haemorrhage...at 31 in Sept 04, I underwent a 10 hour operation followed by another 10 hour operation in March 05. I was transferred to Taunton (from Frenchay) learnt how to walk, talk, etc. I was discharged & admitted as an outpatient to my local trust whom I've had to fight with to get any support, I had to fight to get a speech & Language therapist to treat me to teach me how to swallow properly as I was still having difficulties, I was told I was a low priority as I was under 65. I received Physiotherapy by someone not that experienced & unfortunately the treatment I needed was complex so we together saw an 'expert' once every 6-8 weeks"—
	that is Heather Bright, the clinical specialist in neurological physiotherapy. He continues:
	"All throughout my treatment I was paying for private treatment to get me better as quickly as possible & therefore getting me off of the NHS list too. My local trust has just reassessed me again following some specialist treatment by the world expert Mary Lynch-Ellerington. Heather wrote to Mary asking for her opinion which concluded with Mary saying that I could get better & possibly back to 'normal', I realise there are no guarantees but I'm too young to give up & I don't believe the trust should either. I have asked for alternative help i.e. a referral to another nearby trust that could possibly help or funding so I can do whatever & however much I feel I can do."
	He goes on to say that he raised £11,000 for the NHS by running the marathon a year after he learned to walk. That is just one example; I am sure that other hon. Members can give similar ones. I am still trying to argue with the new primary care trust that he should receive the treatment that he needs.
	What we have heard from Ministers is welcome. I am glad that we are taking strokes and the issues surrounding them seriously and giving them the publicity that they deserve. However, we should not congratulate ourselves too much. I said that the problem is not necessarily age related, and the case that I cited is living proof of that. However, I represent a constituency with a large elderly population, and it is important that they get the same treatment—the same access to scans and, vitally, the same aftercare—as people in other parts of the country. There was much talk at one point about using some of our community hospitals. I am fortunate to have community hospitals in Budleigh Salterton, Sidmouth, Seaton and Axminster, all of which have dedicated staff and good facilities. Perhaps it is to them that we should be looking for this kind of post-care treatment. I am not talking about people going in one or two times a week—there is often 24-hour care, certainly in the early days. The quicker people come to terms with their disability, however temporary, caused by a stroke, the quicker they learn how to live with it, combat it and overcome it, and the quicker they recover and the fewer strains will ultimately be placed on the NHS and local services.
	I am glad that this subject is being debated in the spirit of consensus. There is not much politics in it: it is too serious for that. I hope that the Under-Secretary will have a word with the Minister. As I said, he is now also Minister for the South West and will no doubt wish to ensure in that new capacity that we in my part of Devon are treated the same as Torbay and south Devon so that we can reach the extremely good figures that are being achieved there.

Lee Scott: I have relatives and friends who have suffered strokes, so I am aware how debilitating strokes can be, in both the short and long term. I should like to pay tribute to the two local hospitals serving my constituency, King George hospital and Whipps Cross hospital: may they long continue to offer services to my constituents.
	Every year, more than 110,000 people in England will suffer a stroke, while more than 750,000 live with disabilities caused by strokes. After heart disease and cancer, strokes are the third biggest cause of death in Britain and the largest single cause of severe disability. Almost one third of patients die in the first month after a stroke, with about one in 20 surviving stroke patients needing long-term residential care. As we have heard, three times more women die of strokes than of breast cancer. The NHS pays out more than £2.8 billion treating strokes. Overall, they cost the wider economy about £4.2 billion in lost productivity, disability and informal care. I fully recognise what has already been achieved, but we need to ensure that the public are fully aware of the dangers of strokes and of the crucial need to call 999 immediately if someone is suspected of having a stroke.
	The Healthcare Commission has stated that
	"there is still too much variation, too many places and regions that are not responding as well as they could to minimise the harm done by this serious and common condition",
	and that service providers need to do more. The reality is that patients can face a postcode lottery in the provision and standard of their treatment. There are 640 patients per stroke consultant, compared with 360 patients per cardiac consultant.
	The risk of stroke among African, Caribbean and south Asian men has been found to be far higher than that among the general population. That obviously puts a particular strain on hospitals in London. The risk of stroke increases with age, but each year around 1,000 people under the age of 30 suffer a stroke. I recently met some and was quite shocked by how young they were and how debilitating the condition had made them for years to come. I hope that they will be fully cured.
	The key question that needs to be answered is: what can be done to address the shortage of health professionals with stroke training, which the Select Committee on Public Accounts highlighted as a limiting factor in stroke care provision? If patients are not scanned on the day of admission, they normally have to wait until the next working day. That is a particular problem if they are admitted at the weekend. The sad fact is that only 22 per cent. of victims have a scan on the day they suffer the stroke, and most patients end up waiting for two days or more. In the first few crucial hours after suffering a stroke, it is vital that victims have rapid access to scans to diagnose their condition fully.
	It is not acceptable that only half of all patients receive rehabilitation services that meet their needs in the six months following discharge from hospital, and that after a year that figure falls to a quarter of patients. The Department of Health should evaluate the merits of early supported discharge initiatives and other ways of improving access to treatments. The Department should promote the early adoption of treatments that can be shown to reduce hospital stay and improve patients' chances of recovery. Rehabilitation services must take into account the needs of stroke survivors who live on their own. They may be vulnerable to being overlooked by health and social care services.
	There are difficulties with stroke patients getting access to physiotherapists and social workers. One third of patients who have difficulty swallowing have not been assessed by a speech and language therapist within 72 hours of admission to hospital. The situation is similar for physiotherapy and for occupational therapy, and for social work it is even worse.
	In December 2006, Professor Roger Boyle, the national director for heart disease and stroke, issued the report "Mending hearts and brains—Clinical case for change", which was published by the Department of Health. Professor Boyle noted that the overwhelming majority of cases of heart disease, stroke and related conditions are preventable through healthier lifestyles and preventive medicines. However, he stated that
	"as we—like all developed countries—struggle to defuse the obesity 'time bomb', we cannot afford to be complacent about the threat these diseases pose in the future."
	We could see vast increases in strokes over future years. Professor Boyle suggested that changes in treatment for heart disease also need to be considered for stroke victims. The report noted that if strokes were treated as an emergency, more than 1,000 victims a year would regain independence, rather than dying or being left disabled. Although not all local accident and emergency units are best placed to treat stroke victims, we need to have services on the doorstep or as close as possible for victims.
	A few weeks ago, I joined constituents and my local paper, the  Ilford Recorder, to deliver a "Hands off our hospital!" petition to No. 10 Downing street that had been signed by more than 10,000 people. King George hospital is only 13 years old, but it now faces the prospect of losing some of its key services. That would have a detrimental effect on my constituents. We heard earlier from the Prime Minister that no decisions had been taken, but I have a document, which I am willing to make available to the Under-Secretary, saying that unfortunately certain decisions have been made regarding my local hospital. It is an internal document, given to me by somebody who obviously wishes to remain anonymous, but I would be happy to pass it on to the Under-Secretary, because I am sure that the Prime Minister would not have said what he said if he had been aware of it.
	Although he is not in his place now, the hon. Member for Norwich, North (Dr. Gibson) mentioned the treatment he had received while out in the middle east. I should like to mention Bar-Ilan university, which treats Palestinians and Jews in Israel, and the services that it is doing for brain research. Perhaps we could see twinning with that facility, to help prevent people from having to suffer such a terrible condition and to lead to a better future for all.

Doug Naysmith: The hon. Gentleman makes a good point. There is no doubt that clinical networks have made a real difference in cancer services. The fact that funding was available focused minds and gave them the funds to spend for that purpose. This obviously works. The trouble with having too many priorities, however, is that nothing ends up being a priority. I have had personal experience of a stroke, and it is important to me—and, I think, to many stroke sufferers—that there should be the money available to ensure that the services improve quickly. Otherwise, people who are being asked to commission these services are simply going to say, "Unless we get more money, what are we going to spend less on in order to make the funds available?" Extra funds would therefore be useful. I am conscious, however, that large amounts of extra funds have been put into the NHS over the past 10 years, and a higher proportion is still going in now than ever before. We must ensure that those funds are used wisely, so the hon. Gentleman has made a good point.
	I want to make two further points. First, an early scan is essential, as we have heard. Quoting statistics on the percentage of cases scanned within 24 hours is not useless, but it is not much use. What we need is a three-hour target, and it needs to be met to improve our use of thrombolytic drugs. We must also have 24-hour working, seven days a week, to achieve that. In my opinion, any unit that does not offer that should not have the right to call itself a specialised stroke unit.
	Secondly, I want to emphasise the how important it is that the break between the acute phase—in the consultation document, this is referred to as "time is brain", which is an apt phrase that should be well used—and the beginning of rehabilitation, which is referred to as "life after stroke", is short. In many if not most cases, rehabilitation can and should begin within a few days of the initial event. This means that therapies such as physiotherapy, too, must be available and ready to be used seven days a week.
	I welcome the consultation document. It lays out many things that we in the all-party group have talked about over the past two or three years, and that we know should be put into effect. I hope that the document will provide the means for bringing that about.

Anne Milton: I, too, welcome the debate today. Stroke is often forgotten, and placed at the unglamorous, unsexy end of health care. I trained as a nurse and worked in the NHS for 25 years, and I am only too aware how great the suffering can be, not only for those who have suffered a stroke but for their friends, relatives, neighbours and other carers.
	We have heard many statistics today, and statistics really do matter. They are our only means of emphasising the importance of stroke. It is the third most common cause of death, and the leading cause of disability in adults. Just under 1 million people in this country are living with the after-effects of stroke, and about 300,000 are dependent on others for help with their day-to-day activities. We should remember that for many of those people, even putting on their socks in the morning, or having a piece of toast, cannot happen without the assistance of someone else.
	The Secretary of State has apologised for not being able to be in the Chamber at this moment. He talked about the national service framework for older people, in which stroke is mentioned, but stroke is not just about older people. Twenty-five per cent. of the people affected by stroke are under the age of 65. My hon. Friend the Member for East Devon (Mr. Swire) referred to the fact that the national service framework did not recognise stroke as a neurological disability. It is recognised as such in most countries, but not here, and that has an impact on services.
	I have no doubt that the Government will tell us how much things have improved, and, in the spirit of this debate, it has been important to listen to other Members congratulating the Government, where congratulations are due, on the improvements that have taken place. However, service provision is very patchy. The 2006 national sentinel audit showed that almost three quarters of people with minor stroke are not being managed in specialist units. Only 15 per cent. of patients are admitted to a stroke unit on the day that they have the stroke, and only one tenth of patients are scanned within three hours. These are all crucial indicators for giving people the level of care that they need to improve their outcomes. Some of the work that needs to be done to improve the figures is recognised in the Government's report, but, despite the successes, we must understand how poor some of those figures are.
	If we look a little more deeply into the care of people with stroke, we find that about a third of those who have difficulty swallowing have had no speech or language assessments within the first 72 hours. Early intervention by the non-medical professions is crucial to the outcomes of people following stroke. Those with communication problems can wait up to seven days for that treatment, and it can be even worse for those who want physiotherapy, occupational therapy or a social worker. We are talking here about the acute phase following stroke, not the chronic phase that follows.
	For many of our constituents, it is life after the acute phase of stroke that is important, yet that is when they receive the least attention. My hon. Friend the Member for South Cambridgeshire (Mr. Lansley) mentioned that 80 per cent. of people were unhappy with the services and care that they were receiving a year after stroke. Some of our rehabilitation hospitals are doing a superb job, and I make no apology for mentioning Milford hospital, near my constituency, which is threatened with closure, but is held in considerable affection because of the fantastic work that it has done on rehabilitation.
	I welcome much of the Government's national strategy consultation document, but it also makes the point that there is
	"scope to improve the transition from hospital to the community. Once care in hospital has finished, it can be more difficult to access the support needed".
	I would suggest that for those who are languishing in the community and feel that they were abandoned when they were discharged from hospital, that would seem to be an understatement. It would make frustrating reading for people who are battling away to get the services that they need. I am not making a party political point, but I was a district nurse in the early 1980s, and I remember doing a dissertation at college about discharge from hospital, yet here we are, 25 years on, still saying the same things, and wishing, hoping and fighting for changes in the care of people who have had a stroke.
	Improvement after a stroke continues well beyond the first year. Access to services such as physiotherapy, occupational therapy, speech therapy and advice from dieticians, psychologists and psychiatrists all form a vital part of the care. I would add to that list the housing requirements of people who have had strokes, such as adaptations of people's homes. People can wait up to three, six or even nine months to have a stair rail put into their house, which can transform their ability to manage at home.
	A much disregarded part of care following a stroke is people's mental health, which can be a significant factor in the outcome of someone's illness. Depression, both acute and chronic, can be as debilitating as physical mobility problems. There is also the inability to speak or communicate. The frustration of knowing what word it is one wants to say, but not being able to say it out of one's mouth, is immense, and cannot be understood by any of us who have not suffered it. Depression over the physical limitations on one's body while one's mind remains active can be extremely severe. That is much overlooked and under-diagnosed, and is very rarely treated.

Anne Milton: I share my hon. Friend's alarm that carers are not receiving the needs assessments they require—an issue that has been raised with me by carers' groups. Frequently, such an assessment is referred to as a carer's assessment, and unfortunately carers often feel that they are being assessed, when it is actually the carer's needs. I hark back to personal experience; we have been talking about caring for the carers for decades, and it is crucial. We have talked about the mental ill health of people who have had a stroke, but we must also consider the mental health of those caring for people who have had strokes.

Ann Keen: I start by welcoming the hon. Member for Isle of Wight (Mr. Turner) back into his place today and I commend hon. Members for having the courage to talk about their personal lives and how stroke affected them. The House has led by example today, showing those outside how we can be courageous and how we can reach a consensus, stemming mainly from the work of the all-party group on stroke.
	I would particularly like to praise the group's chairman, the hon. Member for South Cambridgeshire (Mr. Lansley). We joined the House at the same time and have shared many a discussion on the Health Committee. I am pleased to join the team and look forward to further health discussions in future. I think that all members of the all-party group made generous contributions to the document launched by my right hon. Friend the Secretary of State on Monday. I particularly commend the work of Professor Roger Boyle, as members of the group wanted me to thank him and his team for the excellent work they did.
	As the hon. Member for East Devon (Mr. Swire) mentioned, stroke may not necessarily be the best description. I agree that it is really a cerebral-vascular accident, which is how I was trained to describe a stroke. "Brain attack" and other terms used to characterise this serious condition should also be considered—perhaps as part of the consultation.
	The all-party group has raised many important issues for my Department to reflect on for its new strategy. "A New Ambition for Stroke" is now on the table for consultation. I understand why the hon. Member for South Cambridgeshire asked about the continuation of the consultation. In fact, we now need champions to go out and promote the work because there is so much to do and we need to realise that there are different ways of treating this condition. Much good work can be done if we have those champions in place—and I believe that that will develop out of the consultation. We can build on the good progress made by cardiac units. We need to reflect on the arrangements and positioning of cardiac units, which helps to explain why they have been so successful. That is important for future treatment of these emergency brain accidents.
	We are determined to reduce the impact of strokes through our new strategy and to ensure that those who have experienced strokes are well supported through the months and sometimes years of rehabilitation and recovery. That demands a transformation of attitudes. We need to end the pessimism associated with stroke and recognise that it is a preventable and treatable condition. As I said earlier, the courage of hon. Members here today has marked the beginning of the end of that pessimism.
	Medicine is very dynamic and has moved on tremendously. We now know that if we can diagnose strokes quickly and treat them appropriately, there is every chance of helping people to a good recovery. That is why it is important to act now. We have seen a reduction in mortality from strokes and an increase in stroke specialist services. Those achievements and a strong evidence base for stroke care mean that we are now in a position to drive forward improvements in stroke services.
	Modernising the services will not be a quick or easy task. We have a lot to do on prevention, commonly described as "lifestyle." We are now smoke-free across the countries of the UK, we have obesity and exercise programmes and we are looking at a genuinely healthier lifestyle. People need support to change their lifestyle; it is not easy. People cannot be lectured at, and they need help and assistance. I hope that we continue to provide positive and reasonable health education.
	We need to raise awareness of symptoms and improve action on risk factors. We must ensure rapid diagnostics, something that many Members mentioned. We need to improve integration across health and social care, a point raised by the hon. Member for Guildford (Anne Milton), particularly in relation to integration with social services. That is absolutely critical and my ministerial colleagues and I will be working together on it. Much work has been done for carers and I am pleased with the Government's approach in terms of flexible working for carers who are in work, training, a new deal and even pensions.
	The hon. Member for Guildford tried not to make a political point in referring to her time as a district nurse. I, too, nursed through the 1980s and 1990s and I, too, do not wish to make a political point, but many of my patients and families were very cold because they did not have a heating allowance. Their pensions were miserable. Many were trying hard to rehabilitate themselves on small incomes and they did not know whether to put on their heating or to eat. Many of the rehabilitation services were not in place. I hope that we share enthusiasm for change and for the improvements that the Government have made.
	Change is difficult and we need leadership to bring it about. Much has been said about the organisations providing stroke rehabilitation and care. I want to mention a nurse consultant in Portsmouth, Jane Williams, who had the confidence to close an in-patient ward and transfer the resources to community care. She had the confidence, over three years, to win the hearts and minds of more than five organisations, and did it because it made patients feel better to be in their own homes. Care is now provided nearly 24 hours a day, from 7am till 9pm, seven days a week. Those involved work within an inter-professional team and have a better success rate in Portsmouth than they would have achieved in-house. I am sure that the whole House would want to congratulate Jane and her team.
	Ours is an ambitious programme and we know that success is possible. Greater Manchester was mentioned by the hon. Member for South Cambridgeshire, but clinicians have already agreed a strategy to ensure that every stroke patient has the chance to benefit from the clot-busting treatment. Today in London my colleague Professor Ara Darzi has published proposals to develop hyper-specialised stroke centres serving the whole capital. The hon. Member for Ilford, North (Mr. Scott), who raised important points, may like to participate in the review to see how his local services might be affected. We have asked officials to look into the matter and I will get back to the hon. Gentleman.
	It is right to be ambitious as there is overwhelming enthusiasm for the new strategy, not only in this House but from the stroke community. Many people have helped us to develop the consultation document, and I thank all of them. Throughout the country, people with first-hand experience of stroke—survivors, carers and professionals—have told us in no uncertain terms what needs to change. The consultation exercise gives us a chance to listen to a still wider range of voices. I urge Members to contribute and to encourage their constituents to give their views. I will attend my centre at St. Paul's church in Brentford, to which I am a regular visitor. That exercise should give us the opportunity to launch this coming winter a strategy that truly galvanises the revolution in stroke care that we have discussed today.
	Much has rightly been made of the audit report. It says:
	"Stroke clinicians, managers and politicians can feel proud of the advances that have been made over the last ten years—there are few other conditions that have progressed as rapidly."
	We can all be proud of that, and I hope that Members will refer to it when we are in our constituencies.
	Jane made the bold decision to go forward with changes in five organisations over three years. We can only imagine how difficult a task that must have been for a nurse consultant. She told me that she did it because it was right for patients—that it was the right way to progress in the management of care. It is now up to all of us to take up that challenge and to do right by patients.

The House divided: Ayes 195, Noes 300.

Oliver Letwin: I beg to move,
	That this House notes with concern the fact that the United Kingdom comes bottom of a league table of 21 rich countries in a recent UNICEF study of child well-being, has one of the worst drug problems in Europe, has low levels of social mobility, has higher rates of family breakdown than many other European countries and has more people living in severe poverty today than there were in 1997; regrets that sufficiently effective action has not been taken to deal with these problems; recognises that a shared sense of social responsibility is the basis for a more effective response to multiple deprivation and for more effective solutions to the problems of social breakdown; and urges politicians of all parties to join together in an attempt to support families, provide new routes into work, enable people to escape from addiction and indebtedness and to enable voluntary organisations and social enterprises of all sizes to increase their invaluable contribution.
	No subject we could debate is of more importance. Moreover, it is a good sign for British politics that that proposition at least is shared by Members on the two Front Benches and on the Liberal Benches. The subject is of importance not only because of the extraordinary effects of poverty and multiple deprivation on individuals and families, but because of the scale of the problems that we face.
	There is a marked difference in the impression one receives about the country we are living in when one reads the motion and then the amendment. Of course, there is some truth in both the light and the shade, and I do not mean to suggest that Britain is everywhere in the same condition as it is in some places. Much of our country is in splendid condition in many ways. The problem is that much is not, and I shall retail a few of the indicators brought to light in the vast report that we have all been debating and discussing for weeks and months—as we shall continue to do for weeks and months ahead. I shall then try to tackle the question of what is underneath the dispute between the two Front Benches on how we go about curing the problems.
	In 2006, child poverty rose by 100,000 before housing costs, which I think is the Government's preferred measure, or by 200,000 after housing costs. The UNICEF study showed that for child well-being the UK is the lowest rated of 21 Organisation for Economic Co-operation and Development countries.

Oliver Letwin: It is inevitable that any report based on a large amount of statistical accumulation will reflect a period some time before it was published, but as we are considering what is, by agreement, the most important issue before us as a nation, I hope we shall not have to debate the exact use of the present tense in relation to what is inevitably the case about a report.
	In our country, more than 1.2 million young people aged between 16 and 24 are not in work, education or training. The UK has a higher proportion of children living in workless households than any other EU country. That is a really important indicator—I want to come back to that—because, as we should all be able to agree, work is the crucial way out of poverty. I do not think that there is any remaining difference of view between the parties about that. Work is fundamental, so worklessness is fundamental, and the worklessness record is not good.
	It is true that the Government have managed to move some people—a noticeable number of people—out of poverty, as measured by the 60 per cent. of median income line. However, unfortunately, if one looks at the figures carefully, one can see that in general the movement has involved people going from rather slightly below the line to rather slightly above the line. The problem is that, over the past seven or eight years, the number of people living in severe poverty—defined as less than 40 per cent. of the median income—increased by 600,000. In a way, that is the less important point, because it is a point about what has happened recently. The point about our country is that there are now 3.1 million people living on less than 40 per cent. of the median income. That figure is from the Institute for Fiscal Studies. Whatever view one takes of what has been done and is being done, that cannot be right. It cannot be where we are trying to be as a country. To be fair to Members on the Government Front Bench, the right hon. Member for Darlington (Mr. Milburn), the former Secretary of State for Health, was perfectly open about that and said that poverty has become more entrenched. That is a real problem for our country.

Jamie Reed: I hesitate to shatter the emerging, embryonic consensus, but does the right hon. Gentleman share my fear that, given the manifesto on which he and his colleagues stood, people in the country might struggle to take him seriously on these matters?

Oliver Letwin: I do not know who will take what seriously—I am not a psephologist—but in the end what matters is whether the present Government, the next Government and the Governments after that are seriously going to tackle the issue. If the hon. Gentleman thinks that we are not seriously committed to tackling it, he is wrong. We are. We would not have bothered to do the work that we have done on the issue if we were not seriously committed to tackling it. Moreover, we would not be making the argument that I am making, which is that this is the single most important thing we can tackle, unless we intended to tackle it. Just as a matter of political prudence, it would be slightly odd for a party to set itself up to try to tackle something and make that a priority if it thought that it was not going to spend any time or effort trying to tackle it and did not care whether it succeeded or failed. The truth is that we are committed to the issue. I know that it is uncomfortable for the hon. Gentleman and others who wish to be in a partisan position to acknowledge that we may have joint aims—although we may disagree about means—but the truth is that that is the position that we are in, so we ought to recognise it.
	The new deal is a very considerable programme. I see the distinguished right hon. Member for Birkenhead (Mr. Field) in his place. He and many others have pointed out that, despite what are no doubt the best of intentions, the new deal has, to a very considerable degree, failed—in the sense that a large number of the people for whom it finds work unfortunately move back out of work extremely quickly. It has cost about £1.9 billion, but the number of unemployed young people has increased by about 70,000.
	There cannot be anybody in the House—I go back to the right hon. Gentleman: I remember learning about this from him 10 or more years ago—who thinks that it is satisfactory that there are roughly 2.7 million people on incapacity benefit in Britain. That cannot be the position that we ought to be in as a country, especially when many of those people might be able to work, would like to work and are not working.

Chris Bryant: I completely agree with the right hon. Gentleman. It is distressing that nearly one in five people of working age in my constituency is on incapacity benefit. What we have been doing over the past couple of years has had some success. The programme to get people off benefits and into jobs, through Jobcentre Plus, is expensive. There are all sorts of complex reasons involved, particularly in former mining constituencies. I would be interested to hear whether he has any ideas on how one would cut that number. There is no point in just bewailing the situation; one has to have concrete ideas that work in practice.

Oliver Letwin: Yes, we do, and I will come to those ideas in more detail in a moment. However, let me answer the hon. Gentleman so that he does not think that I am evading his question. The proposition put forward in the social justice policy group's report, which is the foundation of our thoughts about these matters, is that we should move to an arrangement under which welfare to work is handled by agencies—whether social or voluntary agencies, or those in the private sector—that are paid by results. Those results should be long-term, not short-term, work. In other words, the agencies should receive remuneration that is related to the benefits that are saved when people move into work and stay in work for a considerable period, so that there is an incentive to help people to remain in work. It then becomes a sensible financial proposition for those enterprises to invest in helping people to become able to work either by trying to do something about their health, or by trying to find them things that are appropriate to their health condition—or both. As a matter of fact, I think that we might be able to achieve some consensus in the House on that. We are certainly considering the proposition seriously.

Frank Field: It is not just a matter of failing. Quite a few of our constituents who have been on benefit for a long time are hesitant to take the risk of moving into work because things might go pear shaped. If we could say to them, "Don't worry. Here's a year's money, and whatever you do will be in order", many of them, although not all, would be able to make that journey without any of us having to interfere in their lives.

Oliver Letwin: I have the same experience of constituents who are frightened about the effect on their benefits of moving into work. We must change that situation. We are looking extremely seriously at propositions that will allow us to achieve that, which must be an aim.

Oliver Letwin: I have just spotted the author of the social justice policy group report, my right hon. Friend the Member for Chingford and Woodford Green (Mr. Duncan Smith); he is sitting behind me, but I will take the liberty of saying that that is precisely the point that the report raises about welfare to work programmes. They need to be carried out by people who have an incentive and a desire not just to find people something that looks like a job for a minute, but to help them into it, to help keep them in it, and to help them to get back into it if they fall out of it. That is a crucial component of such programme.

John Bercow: Is my right hon. Friend aware that, at the last count, there were no fewer than 2,063 young school leavers in Buckinghamshire, Oxfordshire and Milton Keynes not in education, employment or training, 1,000 of whom were in that position because they suffered from the hidden disability of speech, language and communication impairment that had not been treated? Does that not underline the crucial significance of early intervention to tackle those problems, in the interests of both the economy and the fulfilment of individual potential?

Oliver Letwin: Yes—the report looks at a wide range of countries. Reducing harm and reducing death, about which the hon. Gentleman is extremely and rightly concerned, are important aims, but there is a difference. He and I may disagree, to judge by our previous conversations about the matter over the years. The report says, and I agree, that it is not good enough just to prevent harm. What we have to do is to try and lead people, or enable people to lead themselves—it is a reconstruction of personality and ability that we are talking about—out of the condition of addiction into a non-chaotic lifestyle where they can work and be part of the mainstream. So harm reduction is an important goal, but it is not enough.

Gary Streeter: I am grateful to my right hon. Friend who, as usual, is making a lucid and intelligent speech. In relation to young people addicted to drugs, is it not the case that when they make the brave decision that they need help and want to come off their—typically—heroin addiction, it is no good saying to them, "That's fine. Come back in a month and we will find a place for you," or "You will have to join a queue for treatment in five or seven months"? One may as well say that there is no treatment available. It must be now or not at all. That is expensive, but it is a priority. Is there something that my right hon. Friend would like to say about that?

Oliver Letwin: I entirely agree with that. Throughout the work of the report and our consideration of the issue, we need to take into account that the phenomena that I am describing do not just have a social cost and a cost for individuals and families—they also have huge economic costs. Drug addiction is among the largest causes of economic cost, and we ought to be able to balance that in a mature way.

Oliver Letwin: By taking two countries with spectacularly better results in terms of addiction levels than ours, one with one approach and one with another, the hon. Gentleman is proving that there is no absolute truth about this. However, there is good reason to suppose that the Netherlands, which happens to have the lowest rate of addiction in the sample that we are talking about—three or so per 1,000—has a method that is worth pursuing.  [ Interruption . ] The figures that I am citing have been carefully calibrated to include problematic drug users on a consistent basis.

Oliver Letwin: My hon. Friend is obviously right that drug use prevention is enormously important—the report deals with that at some length—but we should not delude ourselves that it will ever be enough. The truth is that rehabilitation is critical to any strategy, and it is of course the more expensive and difficult bit.
	There are other factors. The report deals pretty thoroughly with the question of how indebted our nation is, with not only many people who can afford to be in debt but, unfortunately, many who cannot. On survey evidence, some 7 million to 9 million people in Britain today report themselves as having a serious debt problem. That is a bad situation for the country to be in. By most measures, social mobility is lower in Britain than in Denmark, Norway, Finland, Germany, France or the United States, while family breakdown is higher than in almost any other European country.
	I will bore the House if I go on and on. The picture is clear: there are serious problems with our society that are visited on groups of people who are concentrated in certain neighbourhoods and who suffer from multiple deprivation, rather than from simply one or other of the problems that we are discussing. That nexus of multiple deprivation, so tellingly portrayed in yesterday's report and in its predecessor, "Breakdown Britain", is the problem that we need to grip. I do not know, but I hope that that, too, is a shared analysis. I hope that the Government accept that the problem is not just one thing or another, but a combination of things and the cycle of deprivation that they create. Addiction, indebtedness, worklessness and family breakdown all combine to create not just poverty, but entrapment.
	If we accept that analysis and accept that, while the vast majority of our population is of course mercifully free of that trap of deprivation, we have a moral, social and economic duty to do something about that deprivation, the question then becomes—what? The analysis ought to be shared up to that point, but now we come to the difficult question of how we get at the problem. I certainly do not say, and I never will say, that the Government have not sought to address the problems. It is manifest that they have sought to address them. Therefore, I take comfort from the thought that we share much of the analysis. However, it is equally manifest that the Government's actions have not produced the hoped-for results, because if they had, the picture would not be as it is today, but as it was some years ago.
	To a rational observer, that suggests either a pessimistic conclusion—that it would take almost incalculable efforts of the kind that the Government have been making to achieve those results, or that they or any successor Government will not be able to achieve them—or a much more optimistic conclusion, namely, that there is something deficient about the Government's approach that, if changed, could change the situation. That is the analysis of the report. I hope that I shall not embarrass the right hon. Member for Birkenhead if I say that much of the thinking that lies behind the report is thinking that he was doing 10, 15 or 20 years ago. There has been a long chain of thought about the issue that has not been translated into action.
	I would characterise that thought like this. Approach A says, "Let's do a series of discrete things. Let's spend money on those things and let's ensure, above all, that we get money to people who haven't got it". The Government have tried to do that, nobly and necessarily, but it has not produced the hoped for results. The alternative approach is to say, "Okay, we've got to do that, but we've got to do more. We've actually got to change the way people feel about themselves and their lives, and how they conduct their lives if they're entrapped". Like a judo player, we have to use their weight, so to speak, to achieve the hoped-for result, rather than assuming that top-down action by the Government will achieve it by itself. That is a fundamentally different perspective, and it might be one on which the Minister and I profoundly differ.

Graham Allen: I think that the right hon. Gentleman is feeling his way towards a view—and I hope that it is a consensual view, in a way that it was not a few years ago—that all well-meaning Governments have failed because they have looked to remedial policies and sought to cure the symptoms. I hope that we all—including the right hon. Member for Chingford and Woodford Green (Mr. Duncan Smith) in his excellent contribution to the debate, which was published yesterday—now understand that the problems that we face are inter-generational and cannot be solved by a specific programme to cure particular individuals.
	Does the right hon. Member for West Dorset (Mr. Letwin) accept that we need at least a 20-year prevention programme, or early intervention programme, as we are calling it in my city? Only if we do that will we be able to break the inter-generational cycle. Also—I address this remark to both Front Benches—this will have to be an all-party programme. There will have to be national consensus to pursue such policies, otherwise, at some point in the future, we might find ourselves on the other side of the House, criticising and nit-picking over statistics as another set of policies fails to deliver.

Oliver Letwin: I am terribly sorry, but I will not; I am going to try to finish my speech.
	One of the most important things said in the report is that the state in Britain is paying nothing like enough attention to the ability of civil society to help people to help themselves out of traps of multiple deprivation. I strongly believe that there is a parallel with the argument we all had in the 1970s and 1980s about whether the route to prosperity was through planned economies or free markets. That debate has passed. We all agree that the regulated free market is the engine of prosperity, and thank God for that. It is a huge advance for humanity and for this country. We have to get to a similar position in this case, where we recognise that we are talking about the liberation of energies far beyond those that currently exist, however brilliant a group of Ministers and civil servants there is in Whitehall. If we achieved that transformation, much else that I and the hon. Member for Nottingham, North (Mr. Allen), with his mention of long-term plans, want to achieve could be achieved on a sustainable basis.
	My argument is not merely that there is a problem, that we have to address the causes rather than the symptoms, or that in order to address them we have to find ways of helping people to help themselves rather than simply telling them what to do and how to do it—it is that we must release the energies of a vast centre of activity that is underrated in Britain today. It is impeded unnecessarily, unconsciously and unintentionally by the Government and we can do much more to liberate it and make it effective.

Edward Miliband: I agree with my hon. Friend. I do not wish to introduce a partisan note, but I fear the record of Conservative councils in the past few years in relation to the voluntary sector. My hon. Friend and I had an Adjournment debate about the council's disturbing record in Hammersmith and Fulham, and there are other examples from around the country where the welcome rhetoric about the voluntary sector is not matched by action.
	That takes me to the fourth element of our strategy, which is to draw on the skills of the third sector. I agree with the right hon. Member for West Dorset that often it is the third sector that can best reach out to people and involve them in services, often because staff are drawn from the communities they serve. That is why we have increased funding over the past 10 years for the third sector and are trying to tackle the barriers that frustrate it in delivering public services. It is also why we want to support small organisations that make a particular difference. The right hon. Member for Chingford and Woodford Green and I have talked in the past about the role that small organisations play as part of the social glue of our society.
	I also believe that we must enable charities to campaign, because real social change—which is needed in many of these areas—comes not just from above but from below, and from the campaigning work and advocacy that third sector organisations can do. We must be careful, however. The voluntary sector can play an important role in helping to deliver services, but it must never be used—as my hon. Friend the Member for Ealing, Acton and Shepherd's Bush (Mr. Slaughter) says—as a way of abdicating the state's responsibility to fund public services adequately. That is a cautionary note, if I may say so, for the Opposition in particular.

Tom Levitt: My right hon. Friend makes the strong point that we need large and small organisations active in the sector and helping to deliver services. Does he detect in the report that we are discussing a strong bias against larger organisations, and does he agree that the delivery of the digital hearing aid strategy, for example, could not have been done by a small organisation—it was delivered by the Royal National Institute for Deaf People, working closely with the Government? Has he also noticed that if the Conservative party manifesto commitment to fund the four pillars of the lottery equally—25 per cent. each—were to be implemented, it would cut the amount of lottery money going to small organisations—currently 35 per cent. of lottery funding—by £60 million, which is the equivalent of the awards for all budget?

Edward Miliband: My hon. Friend is right to post a warning, because anxiety about large organisations is a theme in the report. If that is simply about the fact that we need to ensure that small organisations are properly involved and their skills and talents are tapped into, that is right, but many large charities do an extraordinary job in many different ways. I agree with my hon. Friend that we should not have a prejudice against them.
	I have laid out our strategy, but I shall now say something briefly about the Opposition's approach, as exemplified in the speech by the right hon. Member for West Dorset and the document published yesterday. They say that their policies are designed to break the cycle of disadvantage in the early years of a child's life—that is a central part of the report. I welcome that, and I have said that we will look at the proposals.
	There are, however, two areas in which I feel that I must part with the tempting consensus that is breaking out. In an intervention, the right hon. Member for Chingford and Woodford Green said that we should not engage in point-scoring on public spending and how much a policy costs. I agree with that, to an extent, but we would not be discussing the spending implications of this report, which amount to billions of pounds, and I do not criticise the right hon. Gentleman for that, were it not for the fact that the Opposition are committed to cutting public spending as a share of national income.
	I welcome the fact that Opposition Members have come to this debate saying, "We do think that poverty and social justice matter, and that the issues that our society faces are important." However, I fail to understand how they can also say, "As a precondition of deciding our strategy, the one thing that we know is that public spending must fall as a share of national income." I am not asking them to say that it must rise as a share of national income. All I am saying is, do not tell us that we need more spending on dealing with drugs and alcohol, more spending on special needs, more spending on people with learning disabilities and more spending across the board—we share many of those views—yet then say, "But we must cut the state as a share of national income."
	That is the problem for the Conservatives. They are caught between their new-found embrace of social justice, which we welcome, and what their heart tells them they believe in—the smaller state. The right hon. Member for West Dorset is in transition, if I may put it that way. In 2001, in a famous—or infamous—episode, he told the Financial Times that we should cut the share of national income to 35 per cent. of GDP. He then disappeared, and reappeared in a toga in his constituency. I notice that he has not being saying that for the past six years, which I very much welcome. However, we cannot have the grown-up debate that the right hon. Member for Chingford and Woodford Green wants following his report if the Opposition say, "We know we need a smaller state to achieve the outcomes that we want", when nothing in the speech of the right hon. Member for West Dorset suggested that the smaller state was the key.
	That is what is remarkable about this debate. I will be honest—I expected the right hon. Gentleman to say, "And here's why we need to cut public spending. Here's why cutting public spending as a share of national income is the answer to the social problems that we face", but he did not do so. So I suppose I am urging him to go that one step further in his transition, and to say, "Well, look—that is probably not the right approach. It probably isn't right to pre-judge the size of the state in that way. It's probably right to say that in fact, that is an old ideological hang-up from 2001 and the toga episode."
	I will gladly give way to the right hon. Gentleman if he wants to change the Conservative party's policy on this issue. He is its policy guru—he wants to be the Rab Butler of today. After 1945, Rab Butler changed the Conservative party's ideological position out of all recognition. I know that the right hon. Gentleman wants to go down in history as the Rab Butler of his time, so I offer him the opportunity to follow that tradition and to come to the Dispatch Box and be Rab Butler.

John Bercow: I am glad that we are having a proper debate about these matters. The couple penalty issue warrants the closest and most serious scrutiny, and I think that the right hon. Gentleman will need to come back with a somewhat fuller response at some point. There is an honourable view in support of the transferable tax allowance to married couples, but it is not everybody's view. I think it is a thoroughly bad idea; it will be highly expensive; it will not cause anyone to get or stay married who would not otherwise do so; and it sends a detrimental signal to many other people. It should be relegated to the circular filing tray sooner rather than later.

David Laws: We have had an extremely interesting debate so far, involving two of the most thoughtful and generally reasonable Front-Bench Members from the Government and the Conservative party. To do justice to a subject of this breadth—it must be the most important of all the domestic policy challenges—we would need far longer than we have today. However, I hope in a reasonably brief period of time to put on record our views about the issue and some of the policy challenges that we have identified. I hope that I can do so in a way that will leave time for others to contribute to the debate.
	I congratulate the right hon. Member for Chingford and Woodford Green (Mr. Duncan Smith) on his report. I must confess that I, like the Minister, have not managed to read it all yet. Indeed, not only have I not managed to read the section on drug abuse, because of its length, I have not even managed to print it off so far, because I ran out of printer paper while I was printing the rest of the report. The report is a valuable contribution to the debate and I recognise a lot of the characteristics of today's society that are identified in it—in particular, the breakdown of family life in this country over the past three or four decades. The social consequences of that breakdown are important and are issues that all the parties need to think about carefully. It is a matter not only of the consequences, but of what action the Government can usefully take to have an impact on the issues.
	What is striking about the UNICEF report that was published earlier this year, whether or not it is based on slightly out-of-date data—that was a moderately fair point, although I am not sure that it would have changed the overall league table position greatly—is just how badly Britain performs in the league table, not only on some of the relative poverty measures, but on many of the issues that relate to family and child well-being, and factors such as drug and alcohol abuse, which are in the right hon. Gentleman's report. To me that indicates that there is nothing inevitable about the nature of the problems that we have in this country, in their widest sense. If having greater family fluctuation and breakdown than in earlier years, or less social mobility, or more drug and alcohol abuse, were simply characteristics of any liberal society, we would expect to see those problems replicated across a lot of advanced countries, but we do not. The United Kingdom does extremely badly and that is a challenge to us to think about what we can do to have some influence in those areas.

David Laws: The hon. Gentleman makes a half-reasonable point. The factors that he points out would affect particular measures in the UNICEF report; they certainly would not affect others. Any fair analysis of the Government's record would recognise not only that they have sought to do a tremendous amount since 1997, or perhaps more accurately 1999, but that, so far, the results are mixed and that it is too early to say quite how successful they are going to be. These things obviously take a considerable amount of time to work through. That is true of areas such as social mobility, where we are commenting on figures that relate to an earlier time.
	Before I move on to the Government and the present situation, I would like to say that I particularly welcome the fact that the Conservative party is taking an interest in these issues. In fairness to other parties in the House—I am sure that the right hon. Member for West Dorset (Mr. Letwin) would be the first to acknowledge this—although some of the problems identified in the report relate to family breakdown that may have nothing to do with any Government, many of them relate to the problems of unemployment, homelessness and economic breakdown that occurred in the 1980s and 1990s, when his party was in power, and are not unrelated to Conservative party policies. If the report reflects an acknowledgment that the Conservative party must focus on not only economic efficiency, but a fairer society and social mobility, that is a good thing.
	Let me turn to the present situation before I comment briefly on several of the proposals in the report by the right hon. Member for Chingford and Woodford Green and some of the issues that we want to be flagged up. The Government have a record of enormous commitment to tackling many of these problems, even though there is marked ambiguity about their attitude to the breakdown of the family. The Minister's speech did not really touch on whether the Government believe that family breakdown is an enormous cause of social problems and on whether they take the view that they simply do not have any mechanisms to influence that. If we look at what has happened over the past few years, while there are certain signs of improvement as a consequence of the Government's policies, there are big unresolved challenges and areas in which things have moved backwards. When the Minister defends the Government's record, I hope that he will not understate the enormous problems of social breakdown that remain unresolved because if he does, he will be giving up the leadership that his party has displayed over the past few years by failing to recognise how bad some of these problems are.
	Let me draw the Minister's attention to a few specific problems, such as housing. As the Prime Minister acknowledged today, we have gone backwards with regard to access to affordable housing and the number of people on the homeless list since 1997. We now have more children in overcrowded accommodation and outside a stable home environment. Those factors must be enormously important for determining whether someone will do well.
	The Government have exaggerated their achievements on the employment front—perhaps they have started to believe their rhetoric. Yes, this country has a high employment rate compared with several others, but we also have an enormously unequal employment situation. Many double-earning couples are doing quite well, but a huge proportion of people have been out of the work force completely for a long time. That is why while this country has a high employment rate, it manages, bizarrely, to be the EU country with the largest number of children in workless households.
	When we look at employment over the past few decades, we see that the Government's record on the employment rate has been flattered only by the fact that female employment has been increasing over the past 10 or 15 years. Male employment is now 10 per cent. lower than it was in the era of Harold Wilson. An enormous cohort of people—many of whom lost their jobs in the 1980s and 1990s and some of whom went on to incapacity benefit—are still out of the labour market. The fact that almost the same number of people are on incapacity benefit 10 years on from 1997 should worry a Government who came in with a pledge on welfare reform.
	The breakdown of family life is yet to be reversed—hopefully there are signs that the situation is not getting worse, but it is certainly not getting much better—and there is a much greater concentration of deprivation in deprived neighbourhoods. As John Hills recently reported, while the employment rate in social housing estates was almost two thirds a few decades ago, it has plummeted to something like a third. People in deprivation are now more likely to be living with people in those same difficult circumstances. Their children are attending the same schools as children in such circumstances, which reinforces disadvantage. As the UNICEF report indicated, when young people have little hope and few skills, they are far more likely to take the option of having children at an early age and staying out of the labour market, thus resulting in cycles of deprivation. The situation out in the country is slightly gloomier than the Minister allowed for. When he defends an extremely impressive record of commitment, he should not underestimate the problems that exist in any way.
	Let me turn briefly to several of the proposals in the report by the right hon. Member for Chingford and Woodford Green. It was inevitable that a few of them would dominate the media coverage. When I scanned the report as rapidly as I could today, I noted that some of the most interesting proposals were those that would attract the press rather less owing to their very nature. We all know that that happens when we try to get coverage on policy matters. I have no doubt that we—and the Government—will go through the report carefully to see what we agree with, what we can pinch, and what is a good idea. I have no doubt that we will find a great many good ideas in it.
	My concern about the drift of Conservative social justice policy is that it seems to rely on two things, and the Minister for the Cabinet Office touched on one of them in his comments about public expenditure. He mentioned that the Conservative party has got hooked up to a rule that involves reducing the public expenditure growth rate even further than the Government already have to. Investment in public services, whether through the public or the private and voluntary sector, will be that much more difficult for a Conservative Government who stick to that rule. That means that some of the big gains and savings that the right hon. Member for Chingford and Woodford Green mentioned a couple of times in his interventions will be that much more difficult to achieve.
	As I have seen in my constituency, voluntary and private sector groups can play a big role, either as an add-on to state services, or working completely separately from them, but there may still be many cases, including in relation to employment services, in which the state will have to fund the voluntary and private sector provider. If there are rigorous controls over public expenditure growth, it will be very difficult to square the circle, and to fund the proposals properly while still investing in education and health. That is one concern.
	The second concern is that many of the right hon. Gentleman's proposals rely on the hope that the Government can, by pulling various levers, encourage families to stay together. I do not underestimate the possibility of people, particularly those on low incomes, responding to economic incentives. Indeed, that idea is the basis of some of the Government's tax credits; the idea is that people will go to work because there is a working tax credit.
	There is a problem with tax credits, and if the Minister looks again at the report on fraud and error in tax credits that was issued this time last year—there will be another one tomorrow—he will see that the Government reported that almost £400 million-worth of fraud and error in tax credits was simply due to the discrete problem of people who lived together misrepresenting their position, and pretending to live apart. There is no question but that there are problems to do with whether people have incentives to misreport their position. It is more difficult to know whether people are deciding not to couple on the basis of tax credits. As I know from my advice centre, the economic incentives are significant, and should not be underestimated for people on low incomes; the right hon. Member for West Dorset cited that point earlier. We should consider that issue carefully, and although the Minister danced around the boxing ring a bit on that one, I am pleased that he did not completely rule out action; perhaps we will see measures on that issue in the future.
	I am less optimistic about some of the other proposals in the report produced by the right hon. Member for Chingford and Woodford Green; I do not think that they will strengthen the position of married couples in the way that he thinks they will. Earlier today, I spoke to the Institute for Fiscal Studies about transferable allowances, which have been mentioned briefly, and one of the hard facts that it pointed out to me immediately was that the majority of the cost of the transferable allowance will be spent on people who have no children. The right hon. Gentleman's proposal would cost £3.2 billion, and £1.7 billion of that would go to families with no children, whereas his concern, obviously, is to get the money to children.

Iain Duncan Smith: If the hon. Gentleman looks at the report again, he will see that there are sectioned-off processes; the scheme can be broken up, so that we can offer the allowance to children below a certain age, to all couples, or to couples with caring responsibilities. It depends on what we wish to do. All the figures that the hon. Gentleman gave are not exactly correct. I actually set out the IFS figures in the report.

David Laws: That sounds like an echo of the right hon. and learned Member for Rushcliffe (Mr. Clarke) who, when he was beginning to phase out the married couples allowance in the 1990s, said that he knew of many reasons why people got married, but the existence of the married couples allowance had never been one of them.
	I am sceptical about whether a financial incentive would have an impact, but I would consider it if I believed that it would help to deal with some of the problems that we face as a country. I am not sure that I have an ideological objection to it. I am just not sure that it would work. There are also some serious issues—Ministers have sought to raise them—about the effect of sending out that signal on the children we are indirectly trying to affect.
	When thinking about the proposal yesterday I wondered what the House's attitude would be if, instead of a married couples' tax allowance, we were proposing a married couples' enhancement to child benefit. That is, in some ways, what we are saying. We are willing to penalise some families and children and reward others on the basis of those choices. It is a difficult issue. This country has a massive problem with the breakdown of marriage and stable relationships, and I understand why the right hon. Gentleman has given the proposal priority.
	There is no school that I visit in my constituency where the head teacher does not comment on the fact that their job has become so much more difficult over the past 10 or 20 years because of the breakdown of stable families and the consequence of that for their intakes. I am not sure whether the proposal would make the difference.

John Bercow: Surely the juxtaposition of married units against unmarried units is all wrong. Does the hon. Gentleman agree that there can be a very compelling case for giving targeted assistance to households where there are children, whether the household is based on a married couple, an unmarried couple or a single parent, but for the life of me I cannot see is why one should give a prize to people with no children, simply because they happen to be married? It is bizarre.

Iain Duncan Smith: Anyone can make a case that others are being excluded, which is nonsense as regards this proposal, which offers a very focused sort of support. It is about people on marginal incomes—those who would particularly benefit—who are having to make a choice about whether they go to work or try to stay at home for three or four years to look after their children. If it were to go wider, it could also help those who may choose to look after their mother when they get older. As the hon. Gentleman may or may not know, some of the greatest problems for couples arise when they are having to make such choices balanced against the amount of money that they can have. This would not generate an immediate desire for people to get married, but it recognises something that came up endlessly when we produced the report—that many people out there, beyond our own world, have jobs, not careers. If someone is eviscerating chickens on an assembly line in Bradford, that is not a career—they make that choice because they have to, because they cannot afford to bring their family up otherwise. This would be one way of allowing them to make a choice; there may be others.

Stephen Crabb: So much for the consensual tone of the debate so far. The right hon. Member for Manchester, Gorton (Sir Gerald Kaufman) referred to the original proposed title of the debate: "Mending the Broken Society". When we use the phrase "broken society", we at least begin to get close to how many people instinctively feel about the condition of our society today.
	There is a deep unease about what could be called social breakdown, which goes far beyond a lack of income and often describes people who live in highly concentrated communities, experiencing multiple and complex challenges that serve to lock them and their children into a cycle of under-achievement, poverty and unhappiness. We can argue about definitions of poverty, talk about the language—whether we describe it as social exclusion, deprivation or poverty—and discuss the measuring sticks we use to assess the extent of it, but at the end of the day most Members of the House know what we are talking about. The hon. Member for Yeovil (Mr. Laws) talked about the number of head teachers who referred to problems in their schools resulting from family and social breakdown. Many of us see the consequences of that in our surgeries on a Friday, and if we do not see it there, we should see it in social action projects in our constituencies, or at least read about the consequences of the phenomenon in the newspapers.
	When I was flicking through the social justice policy group report last night, I was reminded of a book I read 10 years ago, which made uncomfortable reading for Conservatives at the time. It was a book called "Dark Heart" by a left-wing journalist called Nick Davies, who had spent two years travelling around some of Britain's most deprived communities. He saw teenage boys who had made the passage from local authority care into teenage male prostitution, girls who had been abused as young children and who had gone into prostitution, and people in cycles of substance abuse and addiction—people living on the fringes or outside the law. Flicking through that book, I wondered what he would see if he went back to those same communities 10 years on. I do not pretend that everything has got worse, but on the housing estates which I am familiar with in Walworth, Peckham, Bermondsey and south Hartcliffe in Bristol, or on some of the smaller estates in west Wales, poverty has become more entrenched for many and the situation has got a lot worse.
	After 10 years of this Government, let us not pretend that the blame is all to be laid at their door. We have a shared responsibility, and there has been discussion about how long term some of the challenges are. I was reminded recently of some girls I met on the youth offending wing of Eastwood Park female prison in Gloucestershire. Those girls would have been six or seven years old when this Government came to office, but by that time the course of the lives of many of them would already have been easy to predict. A lot of them would have been victims of abuse and deeply scarred inside. At the age of 16 or 17, many of them have deep, messy scars on their wrists; they wear ugly home-made tattoos and carry expressions of deep hopelessness and despair.
	I found that the most prevalent factors in the lives of those girls were exactly the same for a group of lads in Cardiff prison. The common factors throughout their lives are family breakdown, educational failure, worklessness and substance abuse, and it is those themes that my right hon. Friend the Member for Chingford and Woodford Green (Mr. Duncan Smith) and his group sought to address in their excellent report. I welcome the contribution that the report makes to the discussion. It must be taken seriously on the Opposition Benches, and on the Government Benches too. It provides some hope.
	In the short time that I have left, I would like to make a few points. First, I make a plea to my party's Front Benchers to consider seriously the report's findings and not to allow caution, especially on spending commitments, to prevent them from adopting many of its recommendations. There must be up-front investment to provide some of the solutions, and we need to be ambitious. We might be cautious and afraid of opening up little holes in our public expenditure plans, but the truth is that there is a whopping great hole—a bleeding great hole—in our public finances, which is the £102 billion cost of social breakdown.
	My second plea is to Government Front Benchers for positive engagement on the issue. I know that the Minister has a powerful intellect and a good heart, and I welcome his positive engagement. Too often, when I have raised such issues, Ministers have refused to engage and provided answers to completely different questions. For example, when Ministers have been asked about the number of young people not in education, employment or training, who are doing nothing constructive with their lives, too often they trot out statistics about the fall in youth unemployment. It is a completely different subject. The cohort of 16 to 20-year-olds who fall through the net has been growing at a time when, demographically, the number of 16 to 20-year-olds has been shrinking. In Wales, 12 per cent. of young people are not in education, employment or training. I therefore appeal to the Government to start to engage positively on that.
	Thirdly, let us consider alcohol misuse. At the weekend, there was discussion in the media about one or two recommendations in the large report about tackling the curiously British problem of widespread alcohol misuse and the proposal for a tax hike on alcoholic drinks. The alcohol industry's response was predictable and depressing—it simply dismissed the suggestion out of hand. I do not know whether that policy solution is correct; I would need to consider evidence for elasticity of demand and availability of alternatives and so on. However, we need the drinks industry to respond positively and join the discussion in a way in which it has not done up to now. We should tell it like it is—it is not the drinks industry but the binge drink industry. It makes its money not from people having a pint of beer after a round of golf, but from all the young people who go out on a Friday and Saturday night and get hammered.
	In the past 10 or 20 years, the industry has progressively ramped up the alcohol content of the drinks it sells. A pint of beer nowadays is not the same as a pint of beer 20 years ago. It is now common to buy a pint of beer that is 6° proof; 20 years ago, it would have been 2.5° or 3° proof. That is one reason why alcohol consumption, especially among young people, causes so much damage and devastation. I encourage hon. Members to spend an evening with their local police or in the accident and emergency department of their local hospital, if they still have one, to ascertain the sheer volume of cases that are a direct result of alcohol misuse.
	There has been much discussion of family policy and whether the proposals in the Conservative report will have the suggested impact of encouraging more couples to stay together. There is much more discussion to come. Family breakdown was the most prevalent factor in the lives of the young people I met in Eastwood Park prison and Cardiff prison. Often, their parents were not divorced—they had simply been raised by a lone parent. We do the children of this country a huge disservice by trying to cling to a pretence that we can be neutral about different family structures. A huge body of social science research shows that a child from a broken home or a lone parent family is far more likely to fail at school, turn to crime, be a victim of crime and fall into alcohol and substance misuse.
	When we discuss human rights and international development in the House, we adopt a tone of voice that is different from the note that we strike when discussing other issues. On those subjects, we have a consensual approach to ultimate aims that does not prevent dissent and disagreement about specific policies, but the tone is much more attractive to the public. We need to achieve that tone on the subject of today's debate. We must avoid the petty tribalism and partisanship that will get us nowhere. If we are to make progress and tackle deep-seated, entrenched problems, we need to achieve a consensus on the aims. We can have a robust discussion about how we get there, but we need to change our tone and start engaging with a much wider audience. Perhaps that would also help restore faith in this place.

Jamie Reed: There has been a lot of talk about consensus in today's debate, but it is important to test the breadth and depth of that consensus. I am afraid to say that I, for one, am not convinced of its sincerity and I intend to test it in my contribution today.
	The good news for the Opposition is that the  Daily Mail is delighted by their rehashed Mary Poppins agenda, but the bad news is that their recently beatified patron saint Polly Toynbee is fully depressed by it. I welcome their attempted apostasy, but like the British people I do not believe it—simply because, on the basis of today's comments, there is no evidence to support it. With that in mind, I care too much about the progressive cause, improvement of society and social democracy to turn away willing converts, but any such conversion must recognise past social policy mistakes and the root causes of them. If there is to be a consensus, we must test it.
	My point is that if society is broken, Opposition Members should recognise that it was they who broke it. A strong society needs strong social policies. Key elements of our currently effective social policy include the national minimum wage and the record-breaking increase in public spending on our nation's schools, hospitals and other public services. That must be recognised—those investments not only strengthen the bond of our society, but are the glue that keeps it together. If the Opposition are serious about social cohesion, they must recognise that the failed policies of the past—including lower taxes paid for by less public spending on public services—inevitably resulted in worsening public services and social decline. Those policies were unwanted and unworkable.
	Logically, if the Opposition recognise that truth, they must jettison their proceeds of growth rule, which underpins all that they sought to achieve in office and would also lead to a repeat of the failed policies of the past and their consequences. If they really wish to help improve society, they should commit to its betterment with actions rather than words. To go further, they should support us and support our public expenditure policies.
	I believe in marriage, which is an important and valuable institution, but my commitment to it is personal, not social. I did not marry for the benefit of society and I do not believe that the Government should incentivise lifestyle choices. I am surprised that so many supposedly libertarian Conservatives seem prepared to do so. If minor financial inducements can really make marriages work, perhaps the Leader of the Opposition should consider repealing his flight tax in order to subsidise honeymoon travel—I think that might work. It is a curious juxtaposition when someone claims to want to mend society while creating social divisions between the married and the unmarried.
	It is surely perverse to ask the state to make a judgment on the value of people's unique relationships both within and outside marriage. Would such incentives apply to gay marriages and civil partnerships? If the motivating factor behind such a move is, in part, consideration for the well-being of children, why discriminate against children from relationships and in families outside of married relationships? How many children—the innocent party and unwitting victim of those proposals—would be disadvantaged by this move? As a married father, I have no wish for the state to reward my children for my relationship choice and I do not think that their classmates, whose parents are not married but clearly enjoy stable and loving relationships, should be penalised because of the state's view of their parents' actions. That cannot be right.
	The Opposition are absolutely right to highlight the effects of drug use on our society. Here again, however, I must take issue with them because their prevailing mindset seeks to penalise certain behaviours among the lower social orders while ignoring those same vices or lifestyle choices among the more affluent sections of society. That manifests itself in a particular way in current Conservative thinking.
	The Leader of the Opposition recently announced that he was in favour of lowering the classification of ecstasy from a class A to a class B drug. In the same week, the police in my constituency seized a huge haul of ecstasy. The market for that drug was clearly children and teenagers, whose safety and well-being should not be sacrificed in a desperate search for modernity or, still worse, a headline for the Conservative party. I do not doubt the sincerity of the right hon. Member for Witney (Mr. Cameron) or the intentions of the Opposition more widely, but they must be consistent. If they care about the effect of drug use on our society, the Leader of the Opposition must recant his views and drop his double standards. Talk is cheap—but by their deeds shall we know them.

David Burrowes: It is pleasure to contribute to the debate, in which I have a particular interest as the deputy chairman of the addictions working group. In the short time available, I hope to draw on some of our material. I apologise for the pressure it may have caused on the printing machines that we used to get the report out, but I make no apologies for the depth with which we sought to tackle the problem of addiction to drugs and alcohol. We looked primarily into the underlying causes behind that massive problem of addiction.
	We sought to take the inquiry deeper than some other commissions, which ask the great and the good to give their words of wisdom. We heard from a balance of the great and the good, but we sought to go out to the different areas of the country to hear from those who are profoundly affected, both addicts and their families and those in the field. I hope that the report was informed by their experiences.
	I can also draw upon 11 years of work as a criminal solicitor dealing with many clients who were addicted to drugs and alcohol. We should be concerned both about the 300,000 people with an opiate or cocaine dependency and the increasingly younger people who are being affected by the misuse of alcohol. It is important to look at individuals and, in my years as a criminal solicitor, I have learned that the characteristics of those affected are that they are drug addicts, often with a learning difficulty. They may have come from single-parent homes and had little or no contact with the father or any role model.
	My first client at Enfield police station, who ended up as my last client, graduated through crime to become one of the most prolific burglars in Enfield. He is now serving a stretch at Pentonville, but he had become disconnected from society and consumed by his addiction, which affected those most dear to him. There were times when he connected with society, mainly when he was in his role as a father and he suddenly realised that he had a relationship with society and those around him. It is important for policy makers to capture such individuals at those times and to ensure that they realise that they have a role in society.
	The Government want such people to stop committing crimes, but that is it. They are happy in many ways to see such people parked up on a methadone programme and not going any further. However, we have higher expectation— we want them to recover, become part of society and take their responsibilities seriously as fathers, citizens and employees. Such individuals are parked up in prisons, but some are in other institutions such as hostels, child care facilities and the like. They are most at risk of never getting out of the cul-de-sac they are in.
	The Government have approached that matter by throwing money at it. We talk about public spending, and £7 billion has gone into the fight against drugs. That is no mean amount, but how has it been spent? It has been spent to the detriment of the funding of alcohol dependency treatment, which has suffered a cut of 6 per cent., but it has gone primarily on methadone prescribing, with £111 million—one third of the pooled treatment budget—going into prescription. That is a concern for those in the field, addicts and recovering addicts. In many ways, the expectation has not gone beyond methadone prescribing. There is a place for methadone prescription, but it has to be part of a supportive programme.
	Professor Strang, the director of the national addiction centre—who is often prayed in aid by those supporting a harm reduction approach—says that one of the valid criticisms of some methadone maintenance programmes is that they are "little more than dispensaries." There is no recovery plan or support programme. That is a concern to addicts in particular. Lee, an addict who graduated from the Phoenix programme in Sheffield, said:
	"I was maintained on methadone for years and years and not once did the doctor or drugs worker say, 'Well look have you ever thought about rehab?' You're still in your home town, with the same people, the same drugs, the same everything. And you are very blinkered. Common sense will tell you that you need to get out and break the circle...if you're still there. on a methadone script, people still use, you've got no chance at all. When I first came here, I thought 'I need to get off drugs' and that was it. But then I learnt as I went on, that it was about learning life skills which I never learned from being on heroin and methadone for 22 years."
	The concern now is that we have "geriaddicts" who are simply parked up.
	If one method is the Government throwing money at the problem, the other is targets. Someone once said:
	"Government targets are asking me to view my business in a way that's just not capturing the work that we do. It's about getting bodies into a system, head counting, and just watching them, it's sheep dipping, basically."
	It has also been said that the Government seem to be more concerned with targets and how many people enter treatment than with outcomes and trying to achieve positive results—that they are more concerned about numbers than freeing people from drugs.
	There is a concern that we might be addressing drug addicts simply as statistics—that we are thinking only of targets and ticking boxes, and of removing addicts from the criminal justice system. There is a worry that we have a top-down approach that does not enable them to be freed from their enslavement to drugs and to take part in society, and that that does not enable us to deal with them properly as individuals. The Government's drugs strategy is under review and we might hear more about that later this month. The worry is that that might culminate in the adoption of a paternalistic "we know best" approach that disempowers local people, communities, service providers and commissioners. The best providers are voluntary ones—those offering residential treatments.
	Let me sum up by quoting someone called Leanne. She said:
	"When someone says to me about family values I didn't know what that meant, but now I have a real family and I feel I actually belong somewhere."
	She managed to break out of her cycle of abuse and addiction because those who cared—particularly voluntary and faith-based providers—did not treat her merely as a statistic.

Anne Snelgrove: Although I welcome the Opposition's late conversion on this important matter, I also have reservations about that. Although the Conservatives will never be in power in the coming decades, if they ever are I hope that they will build on the work done by the Labour Government.
	I want to draw attention to the great work being done in my constituency to improve the lot of children and young people from all backgrounds and the danger of any policy that might put that work at risk. Swindon is not a broken society; we face serious challenges, but our society is good, whole and can embrace those who are not currently playing a full part in it.
	Extra Government funding for children—for every child—makes a huge difference. Government funding is helping us to realise the dream that every child should get the best start in life and the support that they need to make the most of their talents. Yesterday, there was a community cohesion meeting at the Drove campus in my constituency. The campus includes Drove primary school, Drove children's centre and Drove social hall and it is a shining example of what can be done with Government funding. I hope that a Minister will visit the Drove centre to see the great work being done by Nick Capstick and his team. Solutions come from the local community, not from national Government. National Government provide the resources and set the framework, but local people must find solutions to their local problems.
	Swindon has a good reputation for community cohesion, but there are tensions—as there are in all our towns and cities. Children and young people from the black and minority ethnic community need to know that the authorities will provide them with support, development and safety.
	In a briefing paper prepared for yesterday's meeting, one young person was quoted as saying:
	"The council don't invest in us, why would we invest in Swindon?"
	It is true that the council could do a great deal more for young people and adopt a more proactive stance on community cohesion. I hope that the council will look at what Nick is doing at the Drove centre and work with him— in the past it has not shown much interest in doing so.
	Because of Government funding, children's centres such as the Drove centre exist and are starting to have the resources they need to reach out to the whole community. I was a county councillor under the previous Tory Government and I remember that we had to scrimp and save to open 20 new nursery classes across Berkshire in the teeth of Conservative opposition. Although I welcome the Conservatives' conversion, I have that memory and I use it as a warning to myself that they might say things but not follow through in the future. The steps towards a solution to the tensions in our society should include building on examples such as Drove primary school's excellent community outreach work and reputation. That includes early intervention in problem families, in which there is a cycle of deprivation over several generations. They are the most difficult families to reach.
	The children's centre services include early learning combined with day care, adult education and links with Jobcentre Plus for parents and carers who wish to consider training or employment. None of that would be possible without the Government's policy framework and I am disappointed that the Opposition do not seek to build on that in their report.
	I have a particular problem with the phrase in the Opposition's motion about
	"higher rates of family breakdown".
	We should not conflate family breakdown with marriage breakdown: they are not the same. Many families remain strong despite the sad occurrence of marriage breakdowns. Family breakdowns can occur in marriages, and we need to bear that in mind. I do not know whether the Opposition meant family breakdown or marriage breakdown, but I suggest that they need to do a little more serious, in-depth thinking about families and marriage.
	I have been happily married, I am glad to say, for 29 years. As my husband subscribes to theyworkforyou.com, I am just giving him notice that it will be our 30th anniversary next year. We have many friends who have been happily married for many years. We also have friends whose marriages have broken down, but they have made a tremendous continuing commitment to their children and their extended families. Other friends of ours have not married, but have very strong families. Marriage is important to me, but it is not for me to dictate how other people should lead their lives. It is certainly not for me, as a married person without any children, to take £20 every week. I want that money to go to families with children who need it, whether they were born in or out of wedlock. It is not the children's fault what their parents decide to do.
	Nick Capstick of the Drove campus says that he is grateful for the resources given to him for children's centres, but that there is a case for improved, targeted and additional funding, above and beyond the usual children's centre funding, from which hard-to-reach communities could benefit. He asks me to congratulate Ministers and the Government on his behalf for what they have done so far, but calls for even greater vision in developing bespoke solutions for certain communities.
	When we make change, we need to do so in a considered and costed way, so that local economies can continue to grow and create opportunities for all our society.

Greg Clark: I begin by congratulating all three Ministers on their new appointments. I know that the two Ministers responsible for today's debate have a long-standing and genuine interest in the matters under discussion. I am an optimist about our society. For many years now, our society has been getting better for most people. We are generally more prosperous, and people have opportunities they used not to have. Our culture is now such that racism, sexism and homophobia, for example, are increasingly unacceptable, which has meant a material improvement in lives that were previously subject to harassment and misery. In many ways, we are becoming a gentler and better society.
	However, that is not true for everyone. Too many people in our society are breaking away from the mainstream and are being left behind. Given that most of us are experiencing improvements in our life chances, we have a particular obligation to take account of those who are struggling and being left behind. I am not going to trade statistics, of which we have heard plenty in today's debate. The report of my right hon. Friend the Member for Chingford and Woodford Green (Mr. Duncan Smith) contains many expert and erudite analyses of the problem.
	Even in my own constituency of Tunbridge Wells, which in many ways is a byword for comfort and prosperity, I have had some shocking experiences. One of the most shocking occurred when I was on patrol with the police on a Friday night. It might surprise you to hear, Madam Deputy Speaker, that Friday night in Tunbridge Wells can be as rowdy as Friday night in other places.  [Interruption.] I invite the hon. Member for Lincoln (Gillian Merron) to experience it; it is quite good fun, as well.
	While I was on patrol with the police, they stopped a group of youths to make an arrest for the suspected theft of a bottle of wine from an off-licence. Observing what went on during that interaction was both shocking and instructive. One of the youths—a young man probably aged 17—was very loud and full of Friday-night brash self-confidence, until he was presented with the stop-and-search form that suspects questioned by the police now have to fill in. When confronted with that form, his behaviour changed completely. Having been aggressive and self-confident, he became embarrassed, almost furtive in his behaviour.
	I thought that something more serious had happened—that he had drugs on his person, and that a relatively trivial incident had become something more major. I drew closer, and discovered that the young man could not deal with a simple form of the sort that we fill in every day of our lives because he could not read or write. He was not proud or complacent about something that was clearly the source of acute embarrassment. He did not want his mates to see that, and so he moved away.
	I mention the incident because, if something like that can happen in Tunbridge Wells, I cannot see how a young man who does not know how to read or wrote after 12 years of education can ever prosper economically, anywhere in the world. Clearly, the education system has let him down, but that is not due to teachers' personal failure. They say that we must look at the home life of young people, because the problem is deep and has many facets. As a result, reports such as that compiled by my right hon. Friend the Member for Chingford and Woodford Green (Mr. Duncan Smith) are exactly the right way to proceed.
	Therefore, I welcome the tone adopted at least initially by the Minister and his colleagues in responding to the debate. We need to approach this matter seriously and in an attempt to achieve consensus.
	I turn now to some of the speeches that have been made. I was a little disappointed by the Minister's speech. I know that he thinks seriously about these matters, but his remarks were defensive of the Government's record and his policy suggestions were cautious. He was inclined to niggle at points that had been made constructively.
	The Minister should not be so defensive and cautious. Where is the ambition that once characterised the Government's approach to these matters? The Labour party set up the first Commission on Social Justice, but no one on the Government Benches spoke with the zeal and energy displayed by my right hon. Friend the Member for Chingford and Woodford Green. That is unfortunate, because not all the ideas can come from this side of the House. I had hoped for greater energy from Labour Members.
	In addition, what is the Government's action plan? The Minister spoke about the Government's actions, but we know what they have done. I am holding the Government's document "Reaching Out—An Action Plan on Social Exclusion", which was published late last year. I do not wish to be rude, but it bears no comparison to the serious piece of work produced by my right hon. Friend the Member for Chingford and Woodford Green. Moreover, the fact that my right hon. Friend relied on people donating their time voluntarily is a sad reflection on the Government's level of ambition.
	The Minister made great play of the tax allowance proposal, but I fear that he has got himself into some confusion on the matter. No less a personage than the Prime Minister has told us that the Government's policy is to support marriage through the taxation system. As we learned from the "Today" programme this morning, and from the Minister yesterday, their plan is to do that through inheritance tax. If the Government's policy is to support marriage through taxation, I suggest that to do so through inheritance tax—at the very point when a marriage ends, sadly, through death—is probably not the best targeted intervention.
	The Minister needs to think carefully about that, and he did not answer my right hon. Friend the Member for Chingford and Woodford Green, who asked whether he supported the argument put by the right hon. Member for Birkenhead (Mr. Field) that the Government should correct the anomaly in the benefits system that imposes on couples a real disincentive to stay together.
	The Liberal Democrat spokesman, the hon. Member for Yeovil (Mr. Laws), made the important point that international comparisons that show us falling behind are, paradoxically, a cause for great optimism. They show that things can be done so much better, and my right hon. Friend the Member for Chingford and Woodford Green has shown that the fact that places such as Sweden and the Netherlands can tackle drugs so much more effectively means that we can do the same here. The title of my right hon. Friend's report—"Breakthrough Britain"—correctly conveys the optimism that Opposition Members share.
	I do not have time to go through all the speeches in the debate, yet I cannot help but comment on the ludicrous contribution from the right hon. Member for Manchester, Gorton (Sir Gerald Kaufman). It is rather sad that he seems to be so lost in the past. The contrast between the intellectual energy and application that my right hon. Friend the Member for Chingford and Woodford Green has brought to the subject could not be greater. I think that we are all sad that the right hon. Gentleman cannot apply his great intellect and experience of Government to the serious problems, instead of rehearsing the battles of the 1997 election. That is a loss to the debate and a loss to the country.
	We have had a vigorous debate. We started with consensus, which deteriorated somewhat during contributions such as that from the right hon. Member for Manchester, Gorton. I end on a note of consensus, however, by congratulating my right hon. Friend the Member for Chingford and Woodford Green on a report that will be debated for many years to come. I am certain that it will shape many of the policies of the next Government.

Phil Hope: We have had a short but important debate. About 20 Members on both sides of the House spoke and intervened with great passion, offering their experience of the needs of children, young people and families in their constituencies. Members—at least those on the Labour Benches—described the great progress that Labour has made in tackling the Conservative legacy of economic and social failure in the 1980s. They described the tremendous work of voluntary organisations and social enterprises in championing the most vulnerable and meeting their needs.
	My first regret about the debate is the failure of the Conservatives to acknowledge, let alone apologise for, the devastation they inflicted on families and communities during their appalling 18 years in government. Like my hon. Friend the Member for Copeland (Mr. Reed), I make no apology for striking a discordant note in the Conservative efforts to present their compassionate face. I was a local councillor. I worked in the third sector throughout the 1980s and the early 1990s and, like my right hon. Friend the Member for Manchester, Gorton (Sir Gerald Kaufman)—who made a brilliant contribution—I saw at first hand the devastating effect of mass unemployment and cuts to public services, which put intolerable pressure on vulnerable families, children, young people and pensioners. I for one will never let the Conservatives duck their responsibility for the poverty, homelessness, mortgage misery, divorce and crime increases. Whole communities were abandoned when they were in power. Groups such as lone parents were stigmatised and scapegoated by the Tories, so I agree with my right hon. Friend that for them now to try to shed their reputation as the nasty party and claim to be the party that will deliver social justice is a little hard to swallow.
	What might have helped the Conservatives' case was some recognition in their document of the enormous progress in economic and social justice the Labour Government have brought about since 1997. The right hon. Member for Chingford and Woodford Green says that he wants consensus on the way forward, but he deliberately—almost perversely—refuses to name, let alone, applaud, the huge improvements of the past 10 years under Labour. Six hundred thousand children have been lifted out of poverty. Unemployment has gone down dramatically and 2.5 million more people are in work, including many more women. Pensioners have not been mentioned in the debate, but 2 million of them no longer live below the poverty line. The number of children living in workless households has dropped. Teenage pregnancies are at their lowest level for 20 years. There are record levels of investment in education, increasing the educational achievement of young people not only in schools but in apprenticeships, which have trebled to 250,000 a year.
	My hon. Friend the Member for Copeland talked about action, not words. He probably does not know that the motto of Corby borough council in my constituency is, "Deeds not Words". The Tories' voting record in opposition, let alone their past in government, tells us all about the sincerity of their commitment. They voted against tax credits, the new deal and the minimum wage. However, it is good to see Members such as the hon. Member for Preseli Pembrokeshire (Mr. Crabb) breaking ranks with his Front Bench. He called for more public spending, clearly opposing Conservative Front Benchers' commitments to cut funding by £21 billion.
	I do not want to be wholly negative. There are some useful suggestions in the Conservative proposals, some of which will appear familiar to my hon. Friends—not least because they are lifted from our policy documents. Imitation is of course the sincerest form of flattery, so I welcome the support in the document for the measures we are already undertaking to support the third sector, about which I shall say a little more later.
	Crucially, the Conservative flagship proposal for a transferable tax allowance is fundamentally flawed. As my right hon. Friend the Minister for the Cabinet Office said, the Tories are taking more than £3 billion from public services and support for families to help married couples who pay tax, most of whom do not have children—the hon. Member for Yeovil (Mr. Laws) forensically took apart the Tory proposals—at the expense of children who are growing up in low-income families.
	I must admit that before the debate I wondered whether others on the Opposition Benches would be happy to support proposals for changing the tax system that would mean that only 3 per cent. of the benefit would go to the poorest 10th of the population. I was delighted that the hon. Member for Buckingham (John Bercow) made it clear in his intervention that he thoroughly disagreed with a proposal that would clearly stigmatise and penalise children in the most disadvantaged families. The Tories have chosen to spin this aspect of their report as something that makes them "the great party of marriage", but as we have seen today they are hopelessly divided among themselves on the proposals. They have no answers to the forensic demolition of what are socially unjust proposals, given the impact that they would have on children in need.
	The truth is that families come in all shapes and sizes and that the Government must support all families, irrespective of their structure. My hon. Friend the Member for South Swindon (Anne Snelgrove) was right to say that it is not the role of the state to say what type of family is best. The real focus of our efforts to tackle inequality should not be on family structures; it should be on supporting children so that they can grow up in loving, stable and supportive families, whatever their circumstances. The issue is about income for those children. It is about financial support through increased child benefits, which the Tories froze when they were in power, and the working families tax credit, which the Tories opposed when they were in opposition. There is the issue of giving children more time with their parents through increased maternity and paternity leave and giving parents that time to be with their children in those crucial early formative months and years. There is also the issue of giving greater support to parents through better access to child care. There are new children's centres and new programmes covering parenting skills and giving advice.
	We do not have a massive problem of family breakdown and it is simply not true to say that we do. My hon. Friend the Member for South Swindon made that point. The vast majority of families are doing well. Parents are doing an excellent job and the outcomes for their children are getting increasingly better. Our challenge is to concentrate our help on those families—the figure is about 2 per cent.—who experience multiple family disadvantages and who have not been reached by the growth of our universal services. We might at least have a consensus on that and on the role of the third sector in meeting those needs. My hon. Friend the Member for Nottingham, North (Mr. Allen), who is not in the Chamber, made an important point about early intervention and preventive work with those families.
	That takes me on to the importance of the third sector. The report states that one of the Conservatives' objectives is to increase the role of the third sector in tackling poverty. As the Minister with responsibility for the third sector, I wholeheartedly agree that voluntary organisations, charities, community groups and social enterprises make a vital contribution. That is why, over the past 10 years, the Government's public support for the third sector has risen from £4.5 billion in 1997 to more than £10.5 billion in 2005. In practical terms, that is reflected in the thousands of community groups and local voluntary organisations that are involved in programmes to support families, communities and those with disabilities. We heard from the hon. Member for Enfield, Southgate (Mr. Burrowes) about those who work with people with addictions. The hon. Member for Preseli Pembrokeshire mentioned those who work with young people in and out of custody. My hon. Friend the Member for South Swindon—a real champion in her community—described the work of the Drove centre in her constituency.
	It has not been possible to acknowledge properly all the contributions made by hon. Members. However, warm words about social justice from Conservative Members cannot hide the facts of their party's record in office and voting record in opposition, or the reality of the stigmatising impact that their party's proposals would have on children in most need. A shiny new façade—

Edward Garnier: I am interested to hear what the Minister has to say, but I am not sure that the logic of her argument suits general Government policy. The Government have been quite happy, through the Attorney-General, to prosecute battalion commanders for ostensibly vicarious responsibility for offences allegedly committed by soldiers under their command in Iraq— [ Interruption. ] Someone from the other side says, "Rightly so." Why, then, is there any distinction in principle that would affect the practice that touches on deaths in custody? The Government cannot have it both ways. If the Minister is arguing that it is right in principle to do this, but not today, what is the difference that makes it right in principle tomorrow but not right in practice today?

Douglas Hogg: I am worried that the opposition should come from the police. Perhaps my hon. Friend will forgive my making this point: some 40 years ago, when I was practising at the criminal Bar—and on a separate occasion when I served as a special constable—I saw in custody unreasonable force being used on people who were detained by the police. It was not fatal in those cases, but it was undoubtedly serious, and the sort of thing that we must guard against.

Andrew Dismore: I welcome my hon. Friend the Under-Secretary to her place on the Front Bench for this debate. I am afraid that it is rather a difficult job to pick up after such a long gestation.
	It is important to recognise the concessions that the Government have made, the most important of which was to extend the Bill to include Crown immunity. I recall our debates over the issue of deaths in custody and I believe that the Government made some significant concessions, which we should acknowledge. The question is whether they go far enough.
	The statutory powers of the prison and probation service ombudsman, the views of the preventing deaths in custody forum and the Government's proposals are built into the Bill. Those are all very positive measures and are sufficient, from my point of view, to represent a compromise. Unfortunately, however, we are left with the question of the date. I am afraid that I have to agree with the House of Lords on that—and, indeed, with what the hon. Member for Beaconsfield (Mr. Grieve) had to say about it. I shall support the Government tonight, but with reluctance, because there is strong merit in the argument that we have heard.
	To develop my earlier intervention, I would be very surprised if it was the police who raised the objections, as this issue has been floating about for some time. My understanding all along was that the police were quite laid back about the extension of the Bill to them. I would be very surprised if their position has changed. The difficulty always was the Prison Service and I recall that several years ago—long before this Bill came before the House—I had a meeting with the present Attorney-General, in her former guise as a Home Office Minister, to discuss previous legislation. I later learned that everything fell apart because of the objections of the Prison Service even then— before we got into the sort of debates that we are conducting now.
	I suspect that the problems still emanate from the Prison Service. If so, it is the wrong position for the service to adopt. A well-run prison has nothing to fear from the extension of deaths in custody to the Prison Service. A well run Prison Service has nothing to fear from that either. The Bill is not about prosecuting people, but about acting as a deterrent to make sure that things are run properly in the first place. We know that the Bill would apply to only a very small number of cases and we hope to see a lever to improve standards, rather than prison managers being prosecuted, which is not the intention.
	If there has been a change, it may be because some people have misunderstood the Bill. It is about not individual liability, but management liability. There is no question of an individual prison officer or police constable facing prosecution under the Bill; the senior management would be held to account. Maybe some of the opposition stems from a misunderstanding of the Bill.

Andrew Dismore: The hon. Gentleman is right and highlights an important anomaly in the Bill. People in custody in a mental institution may not be prisoners—they probably will not have been convicted—but he makes an important point. The examples, while not identical, are similar.
	We come now to the question of the date and there are lots of different ways in which this problem could be dealt with. We could change the wording of the Government amendment from "may" to "shall", which indicates an intention to legislate rather than a permissive power. That would make a significant difference. I would not even press for a date to be in the Bill. We are looking for a target date to which the Government will work to bring the Prison Service up to scratch. It would then know the date by which it has to be sure that it is dealing with the issues properly. A measure tabled along those lines would go a long way towards satisfying the other place. I know that Lord Ramsbotham suggested 1 January 2009, less than 18 months away. That is a rather ambitious timetable, but Ministers naming the day is more important than the specific date.
	My hon. Friend should also resist the suggestion from the other place to extend the deadline for the Bill to 19 or 20 July. Frankly, I cannot see any point in that; either we resolve the issue or we do not, and extending the date will make no difference to the forceful arguments that have been made. We are getting to the constitutional limits of the debate and perhaps if the House finds the Government's case persuasive—sadly, I do not, but I will support the Government because of the reasonable concessions that have been made—the Lords will accept that the elected Chamber should prevail. The Government may win the vote but I do not think they have won the debate. I hope that even at this late stage, my hon. Friends will seek the sort of compromise that appeared to be on offer before.
	Will my hon. Friend the Minister explain what Lord Ramsbotham meant when he said that an offer had been made and then withdrawn? What was that offer and why was it withdrawn? That is a serious point.

David Heath: The hon. Member for Hendon (Mr. Dismore) has left us with a constitutional conundrum. He says that the will of this House must prevail and that that requires the confidence of this House in the Government's arguments. However, he has no confidence in their arguments and yet he will support them to demonstrate the will of the House. That suggests to me that the other place should pay more attention to the arguments in this House than to how it votes.
	I should start by welcoming the Minister to her post. I regret that in her first outing she has to put such a tawdry argument to Members. I regret even more the Government's obstinacy in maintaining a position that has no logical credibility in terms of what they say they want to achieve. It betrays an unfortunate dog-in-the-manger attitude in the face of what has clearly been demonstrated to be broad support for both the Bill's general principles and the measure under discussion. Many Members felt when the right hon. Member for Airdrie and Shotts (John Reid) set down his heavy burden that there might be an opportunity for progress; we are disappointed that that is not the case.
	The Government's position is to accept the arguments made in all parts of the House that death in custody should be part of the remit of the Bill—and they trumpet that as being a great concession—but then to say that they are not prepared to give any indication of when or if the part of the Bill applying to death in custody will ever be implemented. Therefore, the Government are in the same position as St. Augustine of Hippo—they want to be chaste, but not yet. What is the reason for that delay? What is the conceivable purpose in saying, "We think it is wrong to allow gross negligence of a corporate nature in the management of the prison or police services that results in death in custody when a duty of care should apply, but we will let a few people die in the meantime while we think about whether we will implement this measure?" That is, in stark terms, what the Government are saying. They are saying that they will accept a position where such corporate negligence is okay and they will not put a date on the implementation of the death in custody measures.
	The point made by the hon. Member for Hendon is important. This is a corporate manslaughter Bill. It is not individuals who will be found wanting in the execution of their duty; it is management, policies and the structures that are in place. For how long must we expect to wait before an adjustment is made so that we have Prison Service policies that do not allow deaths in custody when they can be avoided by better management? What is the obstacle to the Government going ahead at the fastest speed possible to achieve that?
	The Government say that they want to send a clear signal to the other place, but a clear signal is being sent to them. They should listen to what Back-Bench Labour Members have had to say, not only tonight but on every occasion. Has a single word been uttered from their Benches in support of their position? No, they have been roundly condemned by every contributor to the debate because their position is absurd.
	The statutory basis for a prison ombudsman is welcome, but that measure is in a Bill that is yet to receive its Second Reading and which will be carried over into the next Session, when I am sure that there will be many other issues that will take a long time to discuss. Therefore, that is not an immediate mitigating factor.
	We have offered a number of ways in which the Government could discharge their responsibilities in this respect. We have not said that this must be implemented tomorrow or even next year. We said to the Government to name their date—any date. If they cannot put it in the Bill, they could just name a date in debate. They could say that they intend to ensure that our Prison Service and police service are in a state in which they are no longer grossly negligent in the execution of their duties by whatever date they choose—2009, 2010 or even 2020. If the Government named a date, the House would be satisfied. The obstinate refusal to name a date is what makes people so very irritated with the Government's position.
	I wish to raise one specific issue about the amendment in lieu. I hope that the Minister will explain how we should construe the two parts of amendment (c). It is important that we have a clear statement in subsection (1) of the proposed new clause of the power to extend the meaning of "relevant duty of care". If that takes precedence over subsection (2), I have no problem. But if subsection (2) is a "however" section, so that even if subsection (1) were to be implemented, it could still be reduced in its effect by the exceptions and exemptions in subsection (2), we are no further forward. Can the Minister confirm that the power to extend is the first principle and that anything within subsection (2) is subordinate to subsection (1)? That is an important point, because it will tell us whether there is doublespeak even within the concessions that the Government propose today. I hope that the Minister will reply to that point.
	The Government should have resolved this issue a long time ago. This is an absurd argument and a waste of everybody's time and effort. The concession has been made, so let us get on with it and get it implemented. If the Government cannot do it tonight, surely they will do it at the other end. If we reach 19 July and we still have not resolved the matter, the Government should come back with an extension. That would be absurd and unnecessary, but if it would achieve a resolution of this matter, please let us do it. The best thing we can do is ensure that this Bill, in its entirety, including the duty of care for those in custody, passes through both Houses of Parliament. It could do so tomorrow if the Minister would simply say the right words in responding to this debate.

Douglas Hogg: The Lords are entirely right. Perhaps the House will forgive me if I say that I have a little personal experience of such matters. Many years ago I was a police Minister and, for about 18 months to two years, I was Minister for prisons. I have also been a special constable and, for the last 40 years off and on I have practised at the criminal Bar. As I said in an intervention on my hon. Friend the Member for Beaconsfield (Mr. Grieve), on at least two occasions when I was in the cells—once in my capacity as a special constable and again as a criminal barrister—I saw police officers using force of a wholly unacceptable kind. We know that it happens, and I have also dealt with cases in chambers in which unreasonable force was unquestionably used by police officers. When I was prisons Minister, I was very concerned by some of the standards of behaviour and systems that I saw. I am much reinforced in my view by the fact that Lord Ramsbotham, the former inspector of prisons, is such a strong advocate of this provision.
	I shall not speak for long, as I know other hon. Members wish to speak, but I wish to make some general points. The first is that prisoners, whether in prisons or police cells, are in an extremely vulnerable position. There is very little outside monitoring and, often, very little outside concern. The truth is that, but for a small community of people, our fellow citizens do not care very much about what happens in prisons or police cells. They put it out of their minds. It is a terrible thing that that should be so, but it is so.
	Death or injury in prison or police cells can happen for a variety of reasons. For example, it can happen because of a breakdown in systems. There is the person who is suicidal but not properly watched. There is the person suffering from drug withdrawal whose condition is not properly managed. That constitutes a serious breakdown in the system. Deaths can occur because of dangerous premises—for example, because the authorities, be they the police or the prison authorities, simply have not addressed properly the condition of the premises. Death or injury can occur by reason of the action of fellow prisoners against the deceased person, in cases where the police or the prison authorities should have guarded against that, but did not. Of course, deaths can also occur because police or prison officers act in an irresponsible and gross manner. On that latter category, it is certainly true that the individual officers concerned can be liable under the ordinary principles of common law, but if there has been insufficient supervision, the managers should be responsible as well.
	Given all that, I ask myself whether there is any reason of principle why public authorities should be placed in a different situation from private authorities, and I say that there is no difference of principle of any kind. Indeed, this House has a particular duty to ensure that those in custody, and thus in the care of the state, are properly protected.
	The Government say that they have come up with a compromise. The truth is that it is no proper compromise. I shall respond briefly to the point made by the hon. Member for Somerton and Frome (Mr. Heath) in that regard, and then I will sit down. There is no indication whatsoever of when the provision will be introduced. I agree with my hon. Friend the Member for Beaconsfield, in that I suspect that it will be a very long time in coming, if it comes at all. Secondly and differently, the hon. Member for Somerton and Frome is right in thinking that subsection (2) enables the Minister to "restrict or disapply" the exceptions. My own belief is that it is an additional and overarching measure that is not subordinate to subsection (1).
	The effect of the "compromise", as it is described, is as follows. First, it does not have to be introduced at all. Secondly, through the application of proposed new subsection (2), the safeguard can be so restricted as to be no proper safeguard. That is no compromise. I have spoken for long enough, and I shall sit down as other Members want to speak.

Edward Garnier: We get on fine, but we would get on better if the Government would pay attention to what is said in the other place.
	If the Government have accepted the principle that deaths in custody should come under corporate manslaughter, they should take another look at the Bill. Clause 1(1) describes the offence of corporate manslaughter, stating:
	"An organisation to which this section applies is guilty of an offence if the way in which its activities are managed or organised—
	(a) causes a person's death, and
	(b) amounts to a gross breach of a relevant duty of care owed by the organisation to the deceased."
	As my hon. Friend the Member for Beaconsfield (Mr. Grieve) said—and he has said it probably two, three or four times now—not every death in custody will render the organisation to which we are referring liable for corporate manslaughter. There are plenty of accidental and self-inflicted deaths, as well as deaths by natural causes, in the custodial estate under the control of the Ministry of Justice, but they would never render it or its subordinate organisations liable for corporate manslaughter under the criminal law.
	The Government therefore have no need to worry that a huge collection of criminal summonses will rain down on the Department and capture the Prison Service's director general and senior management. I suspect that only a very few cases will be caught by the law, and they will not only be of the type described by my right hon. and learned Friend the Member for Sleaford and North Hykeham (Mr. Hogg) from his previous experience. In cases such as he set out, in which a police officer goes over the top, that officer could be personally liable for assault, or something worse.
	The number of cases is likely to be low, and the Government appear to have accepted the principle that corporate manslaughter should, at some date as yet unknown, cover prisons and other forms of involuntary custody. That leaves us with the task of working out the real reason why they want to push the date into the distant future. If we analyse what the Government have said, both here and in the other place, in an attempt to understand their responses to the arguments put to them, it is clear that there is no principle involved in their decision. There may be some element of political expediency, but that is not a principle to which our country's courts would be attracted, and it should not be described as such by a Minister of the Crown. As a politician, I fully accept that political expediency plays some part in how we organise our affairs, but to raise it to the level of a matter of legal principle is a mistake, and a mistake that the Government seem to make more and more often.
	When the previous Government came to an end the other day and were replaced by what we were told would be a new, exciting and reforming Government, I hoped we would see some new, reforming and exciting applications of legislation, but we have merely seen the same tired old Ministers, reshuffled, coming up with the same tired old arguments that were introduced on the past several occasions. I am sorry, because I had thought better of the hon. Lady who is dealing with the arguments on behalf of the Government, but I have to suggest that when she read out her she was reading it for the first time; if a woman of her calibre had thought about it more carefully— [ Interruption. ] The duty of the Whip is to keep quiet—occasionally to listen, and perhaps to learn, but to keep quiet. The duty of the Minister is to learn from experience and from the mistakes that the Government made in their previous guise—before the changeover from last time.
	I shall stop, because I have been sufficiently clear and also because the member of the silent service sitting in front of me wants the Minister to do her best to respond. I hope she does, because she and the Government are in trouble if they do not learn the lessons that the other House has taught them and that this House is gently trying to persuade them to remember.

Andrew Rosindell: In this the 25th anniversary year of the British liberation of the Falkland Islands, I am grateful to you, Mr. Deputy Speaker, for giving me this opportunity to speak before the House about the islands, and in so doing to remember that victorious day on 14 June 1982 when the Union flag was once again raised above Stanley following the surrender of Argentine forces who had illegally occupied British territory. As well as reflecting on the events of 1982, I should like to highlight the importance of the Falkland Islands to the United Kingdom today as a British overseas territory, and also the enormous progress that the Falkland Islands have made in economic development a quarter of a century after the conflict ended.
	On 2 April 1982, the Falkland Islands were illegally invaded by Argentina on the orders of the ruling military regime in Buenos Aires. As hon. Members will recall with pride, that invasion was defeated by a taskforce of brave men and women from Her Majesty's armed forces, sent to liberate the islands by Prime Minister Margaret Thatcher, who instinctively knew that it was Britain's moral duty to free the islanders. She never doubted that victory and liberation would be achieved by Britain's courageous fighting men and women. It was because of Mrs. Thatcher's decisive, measured and unwavering resolve that the loyal British subjects of the Falkland Islands are today able to live in freedom and continue to call themselves British, as all Falkland islanders do with immense passion.
	Britain's victory in the South Atlantic not only restored freedom to the Falkland Islands but directly led to democracy in Argentina, which then spread throughout Latin America. It also restored our nation's self-confidence. I could not put it better than to quote the words of Lady Thatcher:
	"The members of our Task Force restored our nation's spirit, they restored our nation's standing, and they gave us back our nation's sense of pride and purpose. We remember them. We salute them."
	Those British troops who made the ultimate sacrifice did so protecting British people—just like you and I, Mr. Deputy Speaker—who, although 8,000 miles away in the South Atlantic, are our kith and kin and had every right to expect Her Majesty's Government to come to their rescue, which they did so gallantly. I also pay tribute to all the personnel who serve today on the islands at Mount Pleasant airbase, continuing to defend the territory 365 days a year.
	I welcome the fact that all Governments since the 1982 conflict have upheld the rights of the people of the Falkland Islands to remain British and consistently refused to discuss the sovereignty of the islands with Argentina. I am grateful to Her Majesty's Government for remaining steadfast and urge them to continue to rebuff all the hostile and illegitimate claims of the Government of the Argentine Republic.
	I am proud to serve as secretary of the all-party Falkland Islands group under the splendid chairmanship of my hon. Friend the Member for Macclesfield (Sir Nicholas Winterton). In that capacity, I have been privileged to attend many ceremonies and commemorative events over the past month to mark this important 25th anniversary. Most particularly, they have included the liberation day commemoration hosted by the Falklands Islands Government at Lincoln's Inn, the dinner hosted by the lord mayor of London at the Guildhall in the presence of Lady Thatcher and, of course, the official Falklands 25 commemoration at Horse Guards parade on Sunday 17 June. Her Majesty's Government should be commended on the organisation of such a great occasion.
	All those commemorative events and many others held this year have rightly shown a sense of jubilation and celebration for the Falkland islanders, in being able to determine their own sovereign path. Those events have also provided a fitting opportunity to remember those 255 magnificent British soldiers, sailors, airmen and civilians who tragically lost their lives in the conflict of 25 years ago. We should also not forget the sad loss of life endured by Argentine forces, all of which could have been avoided if the Government of Buenos Aires had chosen the path of democracy, rather than illegality and aggression.
	Today, the Falklands Islands are a modern, self-confident and prosperous land, proud of their status as a territory of the United Kingdom and determined to uphold their right to choose to remain under the Crown, but increasingly self-assured in running their own affairs and making their own decisions about the future development of the islands. I pay tribute to the Falklands Islands Legislative Council and all its elected Members. They are making great strides in securing economic prosperity and a modern economy for the islands, as well as embarking on many forward-looking policies to develop them for trade, fishing and tourism, while ensuring the protection of the environment and wildlife that lives in abundance on the Falkland Islands.
	I should also like to put on the record my thanks to the Falkland Islands Government representative in the United Kingdom, Miss Sukey Cameron MBE, who works tirelessly to promote the interests of the islands here in London and ensures that the Falklands Islands are never forgotten by hon. Members in all parts of the House. The Falkland Islands Association also continues to do sterling work in supporting the Falkland Islands, under the chairmanship of David Tatham CMG, who served as Governor of the Falkland Islands between 1992 and 1996. Every year in December, I attend the Falklands Islands battle day parade at the Cenotaph in Whitehall organised by the association, and I thank it for all the wonderful work that it does.
	Now that we have celebrated Falklands 25, I hope that we can also celebrate the Falkland Islands as they are today—a modern democratic society, thriving on the fruits of its own ingenuity and enterprise—and that we in the House, together with Her Majesty's Government, can all support the islands as they grow and develop in the future.
	I have been lucky enough to visit the Falkland Islands on two occasions, the most recent of which was in 2005, when I travelled to the south Atlantic as part of my tour of duty with the Royal Air Force and the armed forces parliamentary scheme. On both occasions I could not fail to be struck by one unique feature of the Falkland Islands: the nature and the magnificent wildlife of land, sea and air. I am sure that hon. Members are aware of my keen interest in wildlife, conservation and animal welfare.
	With that in mind, I should like to draw the Minister's attention to a project that is under way on the Falklands Islands. Falklands Conservation needs help with an exciting project to establish a wildlife centre in the heart of the islands' capital, Stanley. A permanent home for Falkland Conservation in this special year is, I believe, an appropriate and positive initiative, which will provide a real and lasting benefit to the islands.
	Falklands Conservation hopes to expand and capitalise on the growing tourist economy that the islands are enjoying. People from across the globe are attracted to the islands by their natural beauty and exceptional wildlife. While such an active, growing and thriving tourist economy is welcome, we must consider the implications of a developing industry for future generations.
	I ask the Minister to meet representatives of Falklands Conservation to discuss how Her Majesty's Government might be able to provide assistance to the islands and help in the development of this excellent project. I believe that a wildlife centre in Stanley of the kind sought by Falklands Conservation could provide the necessary base where tourists, visitors, scientists, naturalists, schoolchildren and the islanders themselves could work together in the best interests of conservation throughout the Falklands.
	One project spearheaded by Falklands Conservation is the albatross protection programme. The Falkland Islands hold the world's largest breeding population of black-browed albatross, as I am sure the Minister is aware. Sadly, however, many of these majestic birds are being killed by long-line fishing. In fact, so many have died as a result of that industry that they are now listed by Birdlife International as an endangered species. The Falklands fishing industry is doing its best to reduce its impact on this migrating bird, and has dramatically cut the mortality rate in Falkland territorial waters, for which it should be commended. Falklands Conservation needs to undertake long-term studies to discover more about the scale of this problem and pinpoint where it is occurring. I urge the Minister to work with it and other international groups to reduce illegal fishing in the south Atlantic and to encourage fishing nations in the locality to adopt proven mitigation methods and legal practices under international guidelines, for the sake of protecting the species.
	May I also ask Her Majesty's Government to work with local conservationists on the islands to help to promote and protect the indigenous penguin population? In particular, there has been a significant decline in the number of rockhopper penguins, whose numbers on the island today are only a fraction of those of a century ago. This is especially worrying when we consider that the Falkland Islands still have the world's largest concentrations of rockhopper and gentoo penguins.
	I am sure that the Minister is well aware of the change in the law that has rightly strengthened the position of Falklands fishing companies by allocating 25-year licences, thus allowing attractive investment opportunities over the long term, especially in the lucrative Asian markets, where certain types of squid are extremely popular and toothfish can fetch up to £20 per kilo.
	I am glad to say that further investment in the islands' future appears likely. The prospect of oil and development drilling work now appears to be on its way. This is a positive step, and I commend the Falkland Islands Government on their decision not to allow any future prospecting to distort the islands' natural beauty, wildlife or conservation projects by insisting that any oil must be loaded offshore.
	It is unfortunate that I should have to return to the issue of Argentina's false and illegal claims to sovereignty of the islands. Given the forthcoming presidential elections in Argentina, however, hot air is rising out of Buenos Aires again, which has made the Falkland Islands a topic of debate in Argentina once more. An example of this can clearly be seen in the decision to bar any company fishing in Falklands territorial waters from trading with Argentina. I hope that the Minister will reassure the House and the islanders that Her Majesty's Government will not in any circumstances enter into any discussions or debate with the present, or any future, Argentine Administration on the subject of sovereignty. Furthermore, does the Minister agree that the Falkland Islands flag should be flown on Horseguards Parade every year for trooping the colour, alongside those of Commonwealth nations? Sadly, it was absent on 16 June 2007, even in this 25th anniversary year.
	Does the Minister agree that a Falkland Islands representative should be invited to lay a wreath at the Cenotaph in Whitehall on Remembrance Sunday each year, alongside representatives from the other British overseas territories and Commonwealth nations, to mark their valuable contribution and to remember those who lost their lives in the protection of Her Majesty's realms and territories?
	I hope that the Minister accepts that those two small gestures would send a positive signal from Her Majesty's Government to the people of the Falkland Islands, and a clear message of pride and patriotism to those who seek to undermine the British Falkland islanders' right to self-determination, their right to remain subjects of the Crown and their right to have the same liberties and freedoms that we, as residents of the British isles and United Kingdom, cherish and defend.

Meg Munn: I begin by congratulating the hon. Member for Romford (Andrew Rosindell) on securing this debate and I commend his efforts to maintain the profile of the UK's overseas territories.
	As the hon. Gentleman outlined, in recent months the Falkland Islands have been very much in our minds. The 25th anniversary provided a fitting opportunity for us to remember the determined efforts of our armed forces in 1982, and the sacrifices of those who gave their lives to restore freedom, democracy and the right to self-determination to the islands. It also provided an opportunity for Falkland islanders to demonstrate to the world their successful development of the islands over the past 25 years, exactly as the hon. Gentleman described. As he will know, the Falkland Islands Government held a well-attended showcase conference in London in April, and I am pleased that my hon. Friend the Member for Pontypridd (Dr. Howells), in his capacity as Minister of State at the Foreign and Commonwealth Office, was able to attend and set out again the Government's commitment to the islands.
	More recently, my right hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow (Mr. Ingram), former Minister of State at the Ministry of Defence, had the opportunity to see matters first hand when he visited the islands last month.
	The Falkland Islands today are a modern, thriving society—self-sufficient in all matters except the cost of defence. The islands have developed a sustainable fisheries industry, tourism continues to grow and the prospect of a hydrocarbons industry remains real. I might return to that point if time allows.
	The economy has been carefully managed by successive Falkland Island Governments. Revenues have been put to good use in the development of education and health services, roads and communications, and most recently a wind farm, which will provide 20 per cent. of the islands' energy requirements'. It is regrettable that the Argentine Government continue to put economic pressure on the islands and political pressure on the UK in an attempt to force us to negotiate sovereignty. That will not work. Our position is clear: we support the islanders' right to self-determination and we will not discuss sovereignty unless and until they wish.
	However, we are keen to foster a constructive relationship with Argentina in the south Atlantic. We have made practical proposals to strengthen the mandate of the South Atlantic Fisheries Commission, including renewing efforts to establish a multilateral high seas fisheries arrangement in the region, in line with best international practice on sustainable fisheries. We have continued our joint work on de-mining, undertaking a feasibility study, and we expect to publish the final report soon. Falkland Islands councillors have agreed that members of families of Argentine armed forces who fell can hold a special commemorative event at the Argentine cemetery at Darwin later this year.
	I thank the hon. Gentleman for his kind comments about the work of the Government and all those who put effort into the UK commemorations. They provided an opportunity for us to commemorate the conflict in a fitting and respectful manner, remembering the fallen on both sides. We are delighted that a national commemorative event held on Horseguards Parade on 17 June was attended by more than 10,000 veterans and members of their families, and that it was watched by 2.3 million viewers on television. The live video link to commemorations on the islands was especially poignant and the weather at San Carlos served as a reminder to us all of the conditions that our forces faced in 1982.
	The hon. Gentleman asked about flying the Falklands flag and I am informed that it is not our practice to fly the flags of any of our overseas territories.
	The South Atlantic Medal Association 82 and Combat Stress organise opportunities for British veterans to return to the Falkland Islands. In 2007, approximately 200 veterans will be able to travel, with priority given to those who have not been back to the Falklands. The pilgrimage will take place in November, during the Falklands summer, and I am pleased that my hon. Friend the Under-Secretary of State for Defence will accompany veterans.
	As the hon. Gentleman said, it is important to remember that the Argentine people also suffered heavy losses in the conflict. We extended an invitation to Argentina to join a separate commemorative event in London, on a date that was acceptable to both parties. We regret that the invitation was declined. We have now, with the agreement of the Falkland Islands Government, offered members of families of the Argentine armed forces who fell in 1982 the opportunity to travel to the islands towards the end of 2007 to hold a private commemorative event at the Argentine cemetery in Darwin.
	The hon. Gentleman mentioned several industries that now exist in the Falkland Islands, including the Falkland Islands fisheries. Since opening the conservation zones in the waters around the Falkland Islands in 1987, the Falkland Islands Government have developed one of the world's best managed and most sustainable fisheries. Islanders hold long-term property rights for maritime resources and have established joint ventures with partners across the world to catch illex and loligo squid and fin fish. Revenues from fisheries now account for more than 40 per cent. of the GDP of the Falkland Islands.
	The hon. Gentleman asked specifically about Falklands Conservation, which works specifically with the Falkland Islands Government to safeguard the unique environment of the islands. We support the project through the overseas territories environment programme fund and I am happy to receive representatives to discuss that. Indeed, tomorrow, I am meeting some Falkland Island councillors and will happily discuss any issues in more detail.
	The hon. Gentleman asked about hydrocarbons. Seven companies currently hold licences for the second round of oil exploration that is under way in the waters around the Falkland Islands. One of those companies is now in a position to commence exploratory drilling and hopes to secure a rig soon. We support the offshore prospecting policy pursued by the Falkland Islands Government, which is entirely consistent with the United Kingdom's sovereignty over the Falkland Islands.
	I reassure the hon. Gentleman and all hon. Members that the Government take seriously their responsibilities to the overseas territories. We are committed to their security, good governance and economic and social development. We have no doubt about our sovereignty over the Falkland Islands and we will continue to uphold the right of Falkland islanders to self-determination. At the same time, despite potential diplomatic challenges, we will continue to look for opportunities for co-operation between the islands and their neighbours in South America.
	Falkland islanders can be proud of their achievements. The sustainable way in which they have developed the islands is an example to us all. If the islands continue to develop confidently and sustainably, islanders should be optimistic about the future.
	 Question put and agreed to.
	 Adjourned accordingly at two minutes to Nine o'clock.